Teamwork simulation training based on a local risk and needs analysis improves the clinical care of trauma patients
Methods: We conducted a local risk, medical errors and needs analysis by reviewing the information obtained by an anonymous hospital-wide trauma care feedback system, results from local trauma registry data, conclusions from trauma morbidity/mortality conferences and interdisciplinary trauma quality circle. These data formed the basis for the course design, which followed the systematics of Kern et al. The interdisciplinary course brings doctors, nurses, and technicians from anesthesia, radiology, trauma, pediatric surgery and pediatric intensive care together, with the objective of cultivating a collaborative mental model and practice for providing patient-centered trauma care. 75 medical professionals took part in the 8-hour-long trauma team simulation course. During the course we investigated the improvement of competencies. To conduct an analysis on a possible effect on clinical treatment, 50 successive trauma resuscitations directly prior, directly after and 6 months after the course were analyzed in regard to completeness of the primary survey and changes in typical missed items identified by the local analysis. This study was conducted at a level 1 trauma center.
Results: Our trauma teams showed significant improvement, both in completeness of the primary survey (67.3 to 80.0%) and improvement of typically missed items, from pre- to post-training. Statistical analysis showed statistical significance for all items (p < 0.01). However, the mid-terms analysis after 6 months showed a decrease in quality for the primary survey (completeness 72.9%) and inconsistent results for typically missed items.
Conclusion: The trauma team simulation course based on a local risk and needs analysis resulted in an improved efficiency of patient care in the trauma resuscitation short term. Regular refresher courses seem to be necessary to sustain the improved team performance over time.