International Journal of Healthcare Simulation

Introduction:

As a collaborative quality improvement project between the Acute General Medicine team (AGM) and the Resuscitation Service, the REsuS project’s primary aim is to enhance resuscitation team leadership skills, alongside developing non-technical skills throughout the responding multi-disciplinary team (MDT).

Initiated in response to a qualitative evaluation of leadership and team dynamics during 2222 calls across the Trust. Informed by Anderson et al.‘s [1] 2021 paper on ‘Best practices for educating and training resuscitation teams for in-hospital cardiac arrest’, the program aligns with themes identified for improving resuscitation management, such as promoting training engagement, clear communication, and responsive leadership.

Methods:

Unanticipated, ‘real-time’ simulations were conducted in 2 acute medical units. The scenarios comprised of a peri-arrest assessment to full cardiopulmonary arrest, prompting emergency-alarm activation and Registrar-led Advanced Life Support response. The ‘in-situ’ and ‘without prior-warning’ approach, integral to this initiative, elicits a genuine response to a medical emergency, utilising the clinical environment, available equipment, and actual clinical staff. Facilitated by an experienced Resuscitation Practitioner and a Critical Care Registrar, using Cooper et al.’s Team Tool©[2], the participants are evaluated for leadership and teamwork. Post-simulation debriefings serve as the pivotal learning phase, highlighting effective practice and areas for improvement in non-technical skills, through feedback and critical self-reflection.

Results:

The ongoing project has a further 8 planned simulations. From the determined power calculation, current projected outcomes aim for a minimum 10% increase in overall Team Tool scores, indicating enhanced leadership and team effectiveness. This current project operates as a pilot study, employing Plan-Do-Study-Act cycles to refine facilitation methods within resource constraints. Concluding by July 2024, documentation of results, the positive impacts, and the challenges, will be highlighted in the presentation.

Discussion:

Engagement with Ward Managers, Consultants, and Service Leads, ensuring pro-active support is vital for the project’s future success. An important component is the proposal of a sustainable version of this leadership programme. Aligning with the NHS’s commitment to continual learning, outlined in the Patient Safety Incident Response Framework [3]. The presentation will highlight the strategies to achieve ongoing sustainability and the proposed integration to the mandatory training pathway for both resuscitation and human factors education.

The REsuS project is a significant undertaking, particularly working within clinical settings with ongoing patient care. Barriers to project implementation include staff availability, time-constraints, and bed-space considerations, exacerbated by the 2023-2024 industrial action. Despite these obstacles, leading this project is highly motivating, with positive feedback and optimistic outcomes.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. Anderson TM, Secrest K, Krein SL, Schildhouse R, Guetterman TC, Harrod M, et al. Best practices for education and training of resuscitation teams for in-hospital cardiac arrest. Circulation: Cardiovascular Quality and Outcomes [Internet]. 2021;14(12). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8759032/.

2. Cooper S, Cant R, Porter J, Sellick K, Somers G, Kinsman L, Nestel D. Rating medical emergency teamwork performance: Development of the Team Emergency Assessment Measure (TEAM). Resuscitation: Simulation and Education [Internet]. 2010;81(4). Available from: https://www.sciencedirect.com/science/article/abs/pii/S0300957209006339?via%3Dihub.

3. NHS England. Patient Safety Incident Response Framework [Internet]. Available from: https://www.england.nhs.uk/patient-safety/patient-safety-insight/incident-response-framework/. [Accessed 5 March 2024].