Translating Military Simulation-Based Trauma Team Research Into Outcomes: LEADing Effective Resuscitations (LEADER)
Abstract
Background and Rationale of Approach: Civilian and military trauma systems aim to eliminate preventable deaths after injury. Effective trauma systems are dependent upon high-quality team leadership and team performance. Failures in team leadership have been linked to over 50% of adverse events in healthcare settings. Trauma teams in particular, depend upon effective team interactions to coordinate, monitor, and adapt their collective skills to accomplish patient care activities. Trauma teams perform complex patient care and medical decision-making under dynamic and time pressured conditions. Such a combination of environmental factors and patient characteristics contributes to frequent breakdowns in team interactions, resulting in poor communication and coordination, failure to recognize threats to patient safety, and overall decreased effectiveness. Recent studies demonstrate that about one-third to one-half of medical errors in trauma care occur during the initial resuscitation of the patient. Considering the volume of trauma patients cared for annually, these errors represent a threat to patients in both military and civilian institutions. This project will develop and test an approach to team leadership training and evaluation that focuses on improving trauma care and patient outcomes. Specifically, we will test the effectiveness of an existing team leadership training bundle (LEADER) that incorporates healthcare simulation-based training. Like flight simulators, healthcare simulation can provide opportunities for realistic practice and is often used to train trauma care providers. However, researchers have yet to link simulation-based trauma training with improved provider performance, patient care, or patient outcomes. This study will evaluate the impact of LEADER training on multiple levels of outcomes, including team leadership, teamwork, patient care, and patient outcomes. This will be accomplished by recording and evaluating actual trauma resuscitations using previously developed measurement tools. Recordings will be de-identified. The data from this research will (1) provide evidence supporting the effectiveness of the LEADER training and (2) be used to refine a simulation-based translational research model (TRANSfeR). Once fully developed, TRANSfeR will be able to guide research and program evaluations that link training interventions with patient outcomes in a variety of healthcare settings and disciplines. Applicability and Impact: The LEADER training intervention will directly impact the care of critically ill trauma patients in both military and civilian settings. Trauma-related injuries are the leading cause of death in Americans ages 1-44 and are responsible for over 29 million emergency department (ED) visits annually. The proposed project is part of a longitudinal research program designed to improve trauma care and trauma patient outcomes by targeting one of the biggest threats to patient safety –- failures in teamwork and leadership errors. The products of this work will provide an effective LEADER intervention that can be disseminated throughout military and civilian settings to improve the performance of healthcare team leaders who must perform under stressful, uncertain situations. While the proposed project targets trauma team leaders, the content and training strategies used in LEADER can be applied to a wide variety of healthcare teams. Furthermore, the investigators will produce a refined TRANSfeR model that can be used to guide research aimed at improving patient outcomes through provider training. We anticipate that education and policy leaders in both military and civilian healthcare systems will be able to immediately incorporate LEADER into current trauma training and sustainment programs. Adapting LEADER for other team types (surgical, cardiac resuscitation, etc.) will require an additional 6 to 12 months. Implementation of the TRANSfeR model into future rese
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810089
Entities
People
- Rosemarie Fernandez
Organizations
- United States Army
- University of Florida