Global perspective on training and staffing for paediatric cardiac critical care.

This manuscript provides a global perspective on physician and nursing education and training in paediatric cardiac critical care, including available resources and delivery of care models with representatives from several regions of the world including Africa, Israel, Asia, Australasia, Europe, South America, and the United States of America.

Reliability of team-based self-monitoring in critical events: a pilot study.

BACKGROUND: Teamwork is a critical component during critical events. Assessment is mandatory for remediation and to target training programmes for observed performance gaps. METHODS: The primary purpose was to test the feasibility of team-based self-monitoring of crisis resource management with a validated teamwork assessment tool. A secondary purpose was to assess item-specific reliability and content validity in order to develop a modified context-optimised assessment tool.We conducted a prospective, single-centre study to assess team-based self-monitoring of teamwork after in-situ inter-professional simulated critical events by comparison with an assessment by observers. The Mayo High Performance Teamwork Scale (MHPTS) was used as the assessment tool with evaluation of internal consistency, item-specific consensus estimates for agreement between participating teams and observers, and content validity. RESULTS: 105 participants and 58 observers completed the MHPTS after a total of 16 simulated critical events over 8 months. Summative internal consistency of the MHPTS calculated as Cronbach's alpha was acceptable with 0.712 for observers and 0.710 for participants. Overall consensus estimates for dichotomous data (agreement/non-agreement) was 0.62 (Cohen's kappa; IQ-range 0.31-0.87). 6/16 items had excellent (kappa > 0.8) and 3/16 good reliability (kappa > 0.6). Short questions concerning easy to observe behaviours were more likely to be reliable. The MHPTS was modified using a threshold for good reliability of kappa > 0.6. The result is a 9 item self-assessment tool (TeamMonitor) with a calculated median kappa of 0.86 (IQ-range: 0.67-1.0) and good content validity. CONCLUSIONS: Team-based self-monitoring with the MHPTS to assess team performance during simulated critical events is feasible. A context-based modification of the tool is achievable with good internal consistency and content validity. Further studies are needed to investigate if team-based self-monitoring may be used as part of a programme of assessment to target training programmes for observed performance gaps.

Impact of an embedded simulation team training programme in a paediatric intensive care unit: a prospective, single-centre, longitudinal study.

PURPOSE: To evaluate the impact of an embedded simulation-based team training programme on perceived performance and to compare the effect over different phases of the programme. METHODS: This was a prospective, single-centre, longitudinal study over the first 2 years of the programme. A total of 219 multidisciplinary health-care professionals participated in simulation sessions, followed by anonymous evaluation questionnaires. The programme was divided into three different phases: introductory (first 6 months), intermediate (second 6 months) and established phase (second year). RESULTS: A total of 88.7% of participants evaluated the impact on overall practice as effective, 56.5% reported a highly effective impact. A total of 90.9% (391/430) of questions on non-technical skills (communication and teamwork) showed an effective impact, 55.6% a highly effective impact, whereas only 70.2% (262/373) of questions on technical skills showed an effective impact. There was a significant (p < 0.001) increased score for effective impact in all categories between the introductory and intermediate phase, which was maintained throughout the established phase. Overall, 72.7% of the participants felt more confident to attend a future critical event, 32.5% were highly confident. In the longitudinal analysis there was a stepwise significant (p < 0.05) increase of confidence of participants. In a subgroup analysis (n = 143) there was a significant (p < 0.001) higher confidence in participants who had attended at least 3 sessions (90.7 vs. 61%). CONCLUSION: There is a 6- to 12-month learning curve in the implementation of an embedded multidisciplinary team training programme. Repeated exposure to simulation is most beneficial to crisis resource management training and single, isolated exposure may not be sufficient.