Elsevier

Australasian Emergency Care

Volume 21, Issue 4, November 2018, Pages 143-149
Australasian Emergency Care

Research paper
Enhancing the training of trauma resuscitation flash teams: A mixed methods study

https://doi.org/10.1016/j.auec.2018.10.002Get rights and content

Abstract

Aims

To determine whether simulated multidisciplinary team training influences teamwork practices and experiences when resuscitating critically injured patients and to generate evidence for training trauma resuscitation flash teams.

Background

Trauma teams perform in stressful situations. They are ‘flash’ teams, mobilised quickly and comprise of different specialties and disciplines. Simulation is promoted as a training strategy. Significant gaps remain in evaluating the impact of this training on clinical practice. Further research is warranted to determine the most effective way to train trauma resuscitation flash team.

Design

Final integration phase of a mixed methods embedded experimental study.

Methods

Primary quantitative results (time to critical operations, facilitators and barriers to teamwork) were merged with supplementary qualitative results (team members’ experiences and perspectives) to explain the influences of simulated multidisciplinary trauma team training on teamwork and patient outcomes.

Results

Four main themes were developed: communication needs to be specific to the emergency context; collaborative decision-making influences resuscitation situations; standardisation promotes efficient trauma care; proficient leadership empowers multidisciplinary teamwork.

Conclusion

Frontline clinicians identified real-world experiences that enable or impede team performance in trauma resuscitations. Our findings ascertain why multidisciplinary team training enhances team performance and what content should be incorporated in training programmes.

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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