Research paperEnhancing the training of trauma resuscitation flash teams: A mixed methods study
Introduction
Trauma is a major contributor to death and disability worldwide. In Australia, almost half a million people are hospitalised each year as a result of injury [1]. Patients who experience major trauma are cared for in designated trauma centres [2], where a multidisciplinary trauma team is responsible for immediate resuscitation and trauma care [3]. Trauma systems rely on effective trauma teams with members who are not only clinically competent, but also proficient in non-technical teamwork skills, and can make time-critical decisions and perform lifesaving interventions [4]. This requires a high level of team performance by an organised team [5]. Whilst the implementation of trauma teams has been shown to improve trauma care [6], preventable errors still occur when teams are dysfunctional [7], [8]. Efforts to improve teamwork include teaching multidisciplinary team members the essential elements of non-technical teamwork skills using simulation [9], [10], [11].
Simulation is promoted as a platform for training teams [10]. Research conducted in 2017 demonstrated that simulated multidisciplinary trauma team training (TTT) in a simulation training laboratory in a New South Wales trauma hospital was associated with improved patient outcomes. There was a reduction in time to critical operation for haemorrhage control in exsanguinating trauma, and critical trauma patients spent less time in the emergency department (ED) [6]. There were also fewer deaths in this group. Research to gain an understanding about the impact of TTT on team performance from the perspective of the trauma team members found that teamwork was the essential component for optimising performance when resuscitating critically injured patients [12].
Potential barriers and facilitators to the clinical application of teamwork skills taught in the simulated multidisciplinary TTT programme have been identified [13]. However, the complexity of trauma care hampers efforts to establish direct links between multidisciplinary team training and improved patient outcomes. There are considerable gaps in knowledge as to how team training impacts health service delivery and patient outcomes [6]. This paper reports on the integration of quantitative and qualitative results from a mixed methods study exploring the impact of simulated multidisciplinary TTT on team performance and trauma patient outcomes at a Level 1 trauma hospital in Australia.
Section snippets
Aim
The aims of this mixed methods study were to:
- 1.
determine how simulated multidisciplinary team training influences team performance and patient outcomes when resuscitating critically injured trauma patients and
- 2.
generate evidence to inform the future design of a TTT programme to prepare multidisciplinary trauma resuscitation teams to treat critically injured trauma patients.
Methods
This paper reports the final integration phase of an embedded experimental mixed methods study, defined by the priority of a quantitative experimental methodology and a supplementary qualitative dataset. In the first phase of this two-phase model, pre–post intervention measures were taken. In the sequential second phase, qualitative data were collected to follow up on and further explain the quantitative results [14], [15]. The primary quantitative results were merged with the subservient
Results
Integration of the quantitative and qualitative data produced four new themes. Quantitative results are represented within the domains of ‘patient outcomes’ and ‘trauma team practices’, and qualitative results are represented in the ‘team members’ experiences’ domain. Trauma team practices are defined as the policies, procedures and protocols that guide practices in real trauma encounters. Team members’ experiences are defined as members’ experiences of teamwork when resuscitating critically
Discussion
Integrating the experiences of multidisciplinary trauma team members with the practices of the trauma team provides insights into team performance during actual trauma resuscitation cases in relation to trauma patient outcomes. These findings reinforce existing knowledge that effective teamwork leads to safer patient care in trauma [8], [19], [20], [21], [22]. Our findings also identify why team training helps trauma resuscitation ‘flash’ teams perform during clinical crises and they highlight
Conclusion
Our study provides four key recommendations to improve the training of trauma resuscitation ‘flash’ teams by blending the perspective of the front-line trauma team members with trauma patient outcomes. This facilitates an understanding of the barriers and facilitators experienced by trauma teams to using the teachings learnt in TTT in real cases and subsequent sustained use in clinical practice. The challenges associated with effective translation of teaching into clinical practice are well
Funding
Margaret Murphy is currently receiving a grant from the Western Sydney Local Health District Research Network Grant Scheme, NSW ($31 361) to support this project.
Conflicts of interest
Margaret Murphy, Andrea McCloughen and Kate Curtis declare that they have no conflict of interest in either the development or conduct of this study.
Author contribution
M.M., K.C., and A.M. conceived and designed the study. K.C. and A.M. oversaw all aspects of the study. M.M. conducted the team survey, interviews and data collection, A.M., M.M. and K.C. conducted the data analysis. All authors have been actively involved in the drafting and critical revision of the manuscript.
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