Multi-disciplinary team-based simulation training in acute care settings: a systematic review of the impact on team performance

Introduction Teamwork plays an essential role in providing quality health care while ensuring good outcomes and safe practices in any healthcare system. This has been demonstrated in several studies in emergency care where resuscitation teams perform at high level to achieve desired outcomes in life threatening situations.1 Simulation has been identified as an effective way of improving team performance skills especially in the acute care settings where team dynamics change rapidly and requires good collaboration.2 In addition to clinical competence, the members of the team also need to be conversant with non-technical skills such as team leadership and communication Methods The MEDLINE, EMBASSE and Cochrane library databases were searched for original articles from the last 20 years, investigating team performance in a multidisciplinary team-based simulation training in acute care settings. The research questions were developed using the participants, intervention, comparisons, outcome (PICO) framework.3 The review was designed and reported in accordance with PRISMA guidelines as shown in figure 1. The articles were then assessed by independent reviewers; using the Critical Appraisal Skills Program (CASP) to standardise the assessment process.4 Results Twelve primary research articles representing a variety of team based simulation training in various acute care settings were included out of the 1260 articles identified. The studies were published between 2002 and 2020 and included 679 participants above age 18 years. The summary of the review findings are shown in table1. All articles were original research paper with combination of pre-post test, observational, randomised, and prospective designs; eleven were single-site studies and one multi-site study. Six studies used pre-post-test interventional study: four used post interventional method and one observational study. One study used prospective blinded controlled observational method. The majority of the articles reviewed were not of high-level evidence and the control aspect of PICO was not applied since the review focused mainly on the intervention and outcome with no comparator. Discussion The review has demonstrated the existence of some evidence that team-based simulation training used in various emergency and acute care clinical settings does improve the team performance. However, how that translate to improvement in patient safety and clinical outcome was not fully addressed by majority of the articles reviewed and other previous studies Conclusion Simulation enhances team training; the evidence to support multidisciplinary team training is positive though limited and will require further research to fully develop and validate simulation based team training programmes. References Walsh BM, Wong AH, Ray JM, Frallicciardi A, Nowicki T, Medzon R, Bentley S, and Stapleton S. Practice Makes Perfect: Simulation in Emergency Medicine Risk Management. Emergency Medicine Clinics of North America 2020;38(2):pp.363–382. Klipfel JM, Gettman MT, Johnson KM, Olson ME, Derscheid DJ, Maxson PM, Arnold JJ, Moehnke DE, Nelson EA and Vierstraete HT. Using high-fidelity simulation to develop nurse-physician teams. The Journal of Continuing Education in Nursing 2011;42(8):pp.347–357 Schardt C, Adams MB, Owens T, Keitz S and Fontelo P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC medical informatics and decision making 2007;7(1):p.16. CASP CRITICAL Appraisal Skills Programme. 2014.Available at: http://www.phru.nhs.uk/pages/PHD/CASP.htm. Accessed May 2019