S. Torres Landa1, R. Caskey1, V. Zoghbi1, J. H. Atkins1, N. N. Williams1, A. D. Brooks1, K. R. Dumon1 1Hospital Of The University Of Pennsylvania,Philadelphia, PA, USA
Introduction:
In-situ simulations of operating room emergencies can lead to increased patient safety and more effective teamwork amongst operating room staff. They also serve to provide training to residents in the ACGME core competencies of practice-based learning and improvement and interpersonal and communication skills. We recently revitalized our in-situ OR simulation program to include one full day per month of training and have also incorporated the TeamSTEPPS® curriculum into the training.
Methods:
Twelve teams were formed for the simulations which include: 12 PGY-2 surgery residents, 24 PGY-3 or PGY-4 anesthesia residents and 36 perioperative registered nurses. Each team then participated in two of the following 30-minute simulations: intra-operative myocardial infarction, acute hemolytic transfusion reaction, massive post-operative hemorrhage in PACU, and tension pneumothorax in PACU. Debriefing was performed following each scenario. All simulations took place in one of the main operating rooms or PACU at our institution. Participants received introductory material about TeamSTEPPS® two weeks prior to the simulations. TeamSTEPPS® concepts were discussed during the debrief following the first simulation and then reinforced with intentional pauses during the second simulation. Participants were surveyed before and after the simulations. All survey questions were rated on a Likert scale of 1-5. Results are listed as average ± standard error of the mean. Average pre and post survey questions were evaluated using a paired t-test.
Results:
Participants self reported increased confidence in all scenarios performed: managing intra-operative myocardial infarction (2.83±0.21 vs 4.08± 0.13, p < 0.01), acute hemolytic transfusion reaction (3.04±0.23 vs 4.04±0.13, p < 0.01), massive post-operative hemorrhage in PACU (3.5±0.15 vs 4.25±0.12, p<0.001), and tension pneumothorax in PACU (2.71±0.17 vs 4.25±0.13, p < 0.001). Participants also reported a significant increase in knowledge of TeamSTEPPS® (2.0±0.17 vs 3.88±0.17, p <0.01). Average participant score for likelihood of using TeamSTEPPS® concepts during a future, real life emergency was 4.38±0.17. Participant opinion of in-situ simulations improved following the training (4.04±0.21 vs 4.63±0.1, p < 0.02).
Conclusion:
In-situ OR simulations led to increased confidence in participants for managing the emergency situations simulated. Incorporation of the TeamSTEPPS® curriculum into our in-situ simulation program resulted in increased knowledge of TeamSTEPPS® concepts amongst participants and led them to report a willingness to use these concepts during real life emergencies. Future evaluations at both the individual and institutional level must be done to determine the lasting impact of this training.