Teamarbeit in pädiatrischen Notfallsituationen nach Inhouse-Simulationstrainings an hessischen Kinderkliniken

Cardiopulmonary resuscitations in children are rare events both in and out of the hospital. Worldwide, the incidence of these emergencies outside the hospital ranges from 3 to 20/100,000 children. In-hospital, approximately 3-6% of children admitted to a pediatric intensive care unit require resuscitation, and such events are much rarer in peripheral units. Routine in managing those low-frequency events cannot be achieved in everyday clinical practice, which can be demonstrated by a lack of guideline adherence, errors in the technical execution of a resuscitation, and delays in the start of chest compressions and defibrillation. However, teamwork also has an impact on the management of pediatric resuscitations. Optimization of non-technical skills, such as team leadership and communication, can help improve the likelihood of survival of patients after cardiovascular arrest and improve performing resuscitations. Simulation training can provide repeated practice of both technical and non-technical skills in a protected environment. The current guidelines of the ERC ("European Resuscitation Council") on cardiopulmonary resuscitation recommend the integration of simulation training in medical education. The present prospective intervention study investigated how teamwork during pediatric emergencies changes after having previously completed a simulation training. 188 interprofessional medical staff members from 11 pediatric hospitals participated in the standardized, two-day training. The training consisted of theory on pediatric advanced life support and crew resource management as well as simulated practice scenarios of pediatric emergencies including structured debriefing. In interprofessional teams, study scenarios (so-called pre- and post-tests) were conducted and video-documented both before and after the simulation training. In these scenarios, team leadership, communication, team spirit, situational and task management and overall performance were assessed by blinded raters using the validated “Team Emergency Assessment Measure”-checklist. In addition, this study examined whether the team leader’s professional status or a resuscitation training completed in the past year made an impact on the ratings of leader-ship, communication and overall performance from pre- to posttest. 82 physicians and 92 nurses (95.2% of the participants) gave their consent to participate in the study. A total of 47 pre-test and 46 post-test videos were analyzed. Regarding to the analysis of the team leaders, 46 pre-test- and 42 post-test videos could be evaluated. Significant improvements were made in all elements of non-technical skills examined: team leadership (pre-test 1.9 vs. post-test 2.6 points), communication (2.0 vs. 2.6 points), team spirit (2.7 vs. 3.3 points), situation management (2.0 vs. 2.7 points), task management (1.9 vs. 2.8 points), and overall performance (5.3 vs. 7.0 points). The significance level was set at 0.05. Thus, it was demonstrated in this work that structured simulation training could significantly improve teamwork in the context of a pediatric emergency. In addition, significant improvements in team leadership, communication, and overall performance were shown when the team was led by a team leader who had attended resuscitation training within the previous 12 months. Residents benefited most from the intervention: they achieved significant improvements as team leaders in all elements studied, whereas attending physicians helped their teams achieve significant performance improvement in only two of three elements (communication and overall performance). Our study shows that a now well-established training tool, simulation, which was initially used to practice technical skills, can be used to adequately train and even significantly improve team skills. There should be a greater awareness of the influence and importance of non-technical skills on patient safety, error minimization and interprofessional collaboration in clinical practice, and regular simulation training should be integrated into the education and training of medical professionals. There is a need to extend the research on whether a certain part of the simulation training has been decisive for the improvements mentioned and to what extent these results influence the outcome of pediatric patients. In addition, research should be conducted to determine how long the improvements achieved will last.