Ambrose H Wong1, Marc A Auerbach, Halley Ruppel, Lauren J Crispino, Alana Rosenberg, Joanne D Iennaco, Federico E Vaca. 1. From the Department of Emergency Medicine (A.H.W., F.E.V.), Yale School of Medicine; Departments of Emergency Medicine and Pediatrics (M.A.A.), Yale School of Medicine; Yale School of Nursing (H.R., J.D.I.); Rowan University School of Osteopathic Medicine (L.C.); and Yale School of Public Health (A.P.R.), New Haven, CT.
Abstract
INTRODUCTION: Emergency departments (EDs) have seen harm rise for both patients and health workers from an increasing rate of agitation events. Team effectiveness during care of this population is particularly challenging because fear of physical harm leads to competing interests. Simulation is frequently employed to improve teamwork in medical resuscitations but has not yet been reported to address team-based behavioral emergency care. As part of a larger investigation of agitated patient care, we designed this secondary study to examine the impact of an interprofessional standardized patient simulation for ED agitation management. METHODS: We used a mixed-methods approach with emergency medicine resident and attending physicians, Physician Assistants (PAs) and Advanced Practice Registered Nurses (APRNs), ED nurses, technicians, and security officers at two hospital sites. After a simulated agitated patient encounter, we conducted uniprofessional and interprofessional focus groups. We undertook structured thematic analysis using a grounded theory approach. Quantitative data consisted of responses to the KidSIM Questionnaire addressing teamwork and simulation-based learning attitudes before and after each session. RESULTS: We reached data saturation with 57 participants. KidSIM scores revealed significant improvements in attitudes toward relevance of simulation, opportunities for interprofessional education, and situation awareness, as well as four of six questions for roles/responsibilities. Two broad themes emerged from the focus groups: (1) a team-based agitated patient simulation addressed dual safety of staff and patients simultaneously and (2) the experience fostered interprofessional discovery and cooperation in agitation management. CONCLUSIONS: A team-based simulated agitated patient encounter highlighted the need to consider the dual safety of staff and patients while facilitating interprofessional dialog and learning. Our findings suggest that simulation may be effective to enhance teamwork in behavioral emergency care.
INTRODUCTION: Emergency departments (EDs) have seen harm rise for both patients and health workers from an increasing rate of agitation events. Team effectiveness during care of this population is particularly challenging because fear of physical harm leads to competing interests. Simulation is frequently employed to improve teamwork in medical resuscitations but has not yet been reported to address team-based behavioral emergency care. As part of a larger investigation of agitated patient care, we designed this secondary study to examine the impact of an interprofessional standardized patient simulation for ED agitation management. METHODS: We used a mixed-methods approach with emergency medicine resident and attending physicians, Physician Assistants (PAs) and Advanced Practice Registered Nurses (APRNs), ED nurses, technicians, and security officers at two hospital sites. After a simulated agitated patient encounter, we conducted uniprofessional and interprofessional focus groups. We undertook structured thematic analysis using a grounded theory approach. Quantitative data consisted of responses to the KidSIM Questionnaire addressing teamwork and simulation-based learning attitudes before and after each session. RESULTS: We reached data saturation with 57 participants. KidSIM scores revealed significant improvements in attitudes toward relevance of simulation, opportunities for interprofessional education, and situation awareness, as well as four of six questions for roles/responsibilities. Two broad themes emerged from the focus groups: (1) a team-based agitated patient simulation addressed dual safety of staff and patients simultaneously and (2) the experience fostered interprofessional discovery and cooperation in agitation management. CONCLUSIONS: A team-based simulated agitated patient encounter highlighted the need to consider the dual safety of staff and patients while facilitating interprofessional dialog and learning. Our findings suggest that simulation may be effective to enhance teamwork in behavioral emergency care.
Authors: Ambrose H Wong; Jessica M Ray; Laura D Cramer; Taylor K Brashear; Christopher Eixenberger; Caitlin McVaney; Jeanie Haggan; Mark Sevilla; Donald S Costa; Vivek Parwani; Andrew Ulrich; James D Dziura; Steven L Bernstein; Arjun K Venkatesh Journal: Ann Emerg Med Date: 2021-12-01 Impact factor: 6.762
Authors: Ambrose H Wong; Jessica M Ray; Marc A Auerbach; Arjun K Venkatesh; Caitlin McVaney; Danielle Burness; Christopher Chmura; Thomas Saxa; Mark Sevilla; Colin T Flood; Amitkumar Patel; Travis Whitfill; James D Dziura; Kimberly A Yonkers; Andrew Ulrich; Steven L Bernstein Journal: BMJ Open Date: 2020-06-30 Impact factor: 2.692