Igniting a Fire for Patient Safety in the or Using Teamstepps and Simulation Observation

The purpose of this  successful continuous improvement project was to assess the current state of teamwork and communication skill among the operating room team, including the CRNAs and Anesthesiologists, then provide an evidence-based patient safety program training session to improve those constructs. Evaluation for sustainability would then be assessed within 3 months of the project implementation.

 The clinical questions were: (1) Does the implementation of a TeamSTEPPS training program in the OR cause an improvement in simulation scores in either or both communication and mutual support/teamwork skills post-training? (2) What are the employee’s attitudes about the TeamSTEPPS training? (3) Was the simulation experience satisfying to the employee undergoing the testing? (4) Was the intervention sustained three months post-training?

 The project design included a pre- and post-simulation observation assessment with a high fidelity mannequin, as the OR team engaged in a validated true- life scenario. Kolb’s’ Theory of Experiential Learning drove the simulation and educational sessions. The intervention was done using the TeamSTEPPS modules and a post education evaluation was done with the TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ). After simulation sessions post intervention, a measure of that experience was done with the Satisfaction in Simulation Experience (SSES) tool. Three months later a short survey (T-TAQ 2) was done to assess sustainability.

T-TAQ scores were significantly different in the positive responses from the anesthesia team as compared to the OR team (p=0.227) after the education session. The results of the SSES tool indicated a high percentage (98%-100%) of participants either agreed or strongly agreed that the experience was satisfactory. The Sustainability Scale revealed 66% of the participants indicated that some improvement in communication and mutual support occurred and there was also a desire by the CRNAs for refresher training in the future. Improvements were noted in both modules. Pre- intervention scores for communication were 65%, and post 89%. For mutual support (teamwork) they were 67% pre and 90% post.

        Along with the statistical support of this project the main gains from this intervention was three-fold.  First, many employees within the OR and anesthesia teams had not participated in simulation previously and this provided an opportunity to practice their new skills in a safe environment for patients. Secondly, it provided the simulation excellence team who provided the experience an opportunity to evaluate their sessions with a validated, reliable tool. Lastly, it inspired spread of this rigorous patient safety program within the organization resulting in other departments who either started using TeamSTEPPS or will begin implementing the program soon.