Advanced Cardiac Life Support training: comparison of physicians and nurses with teamwork-based high-fidelity simulation Tzu-Meng Yang MD, Yuan Kao MD, Chia-Ti Wang MD, Min-Hsien Chung MD, Hung-Jung Lin MD, MBA, Shio-Jean Lin MD, M.D,.M.P.H,. ScD How-Ran Guo, Shih-Bin Su MD, PhD, Chien-Cheng Huang MD, Chien-Chin Hsu MD, PhD PII: DOI: Reference:
S0735-6757(14)00350-7 doi: 10.1016/j.ajem.2014.05.027 YAJEM 54310
To appear in:
American Journal of Emergency Medicine
Received date: Revised date: Accepted date:
6 May 2014 19 May 2014 19 May 2014
Please cite this article as: Yang Tzu-Meng, Kao Yuan, Wang Chia-Ti, Chung Min-Hsien, Lin Hung-Jung, Lin Shio-Jean, How-Ran Guo M.D,.M.P.H,. ScD, Su Shih-Bin, Huang Chien-Cheng, Hsu Chien-Chin, Advanced Cardiac Life Support training: comparison of physicians and nurses with teamwork-based high-fidelity simulation, American Journal of Emergency Medicine (2014), doi: 10.1016/j.ajem.2014.05.027
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Advanced Cardiac Life Support training: comparison of physicians and nurses with teamwork-based high-fidelity simulation
T
Tzu-Meng Yang, MD1,+, Yuan Kao, MD1,+, Chia-Ti Wang, MD1, Min-Hsien Chung, MD1,2,
RI P
Hung-Jung Lin, MD, MBA1,3,4, Shio-Jean Lin, MD5, How-Ran Guo, MD, MPH, ScD6,7, Shih-Bin Su, MD, PhD8,9,10, Chien-Cheng Huang, MD1,11, Chien-Chin Hsu, MD, PhD1,4 Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
2
Department of Emergency Medicine, Chi-Mei Medical Center, Liouying, Tainan, Taiwan
3
Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
4
Department of Biotechnology, Southern Taiwan University of Science and Technology,
MA NU
SC
1
Tainan, Taiwan
Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan
6
Department of Environmental and Occupational Health, College of Medicine, National
ED
5
7
PT
Cheng Kung University, Tainan, Taiwan Department of Occupational and Environmental Medicine, National Cheng Kung University
CE
Hospital, Tainan, Taiwan
Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan
9
Department of Leisure, Recreation and Tourism Management, Southern Taiwan University
AC
8
of Science and Technology, Tainan, Taiwan 10
11
Department of Medical Research, Chi Mei Medical Center, Liouying, Tainan, Taiwan
Department of Child Care and Education, Southern Taiwan University of Science and
Technology, Tainan, Taiwan
Running title: ACLS with teamwork-based high-fidelity simulation +
These authors contributed equally to this work as first authors
ACCEPTED MANUSCRIPT Corresponding Authors: Chien-Cheng Huang, MD, Department of Emergency Medicine, Chi-Mei Medical Center,
T
901 Zhonghua Road, Yongkang District, Tainan City 710, Taiwan.
RI P
Tel: +886-6-281-2811; Fax: +886-6-281-6161; Email: [email protected] Chien-Chin Hsu, MD, PhD, Department of Emergency Medicine, Chi-Mei Medical Center,
SC
901 Zhonghua Road, Yongkang District, Tainan City 710, Taiwan.
Tel: +886-6-281-2811; Fax: +886-6-281-6161; Email: [email protected]
MA NU
Number of Tables: 4 Number of Figures: 1
AC
CE
PT
ED
Word counts: 799
ACCEPTED MANUSCRIPT To the Editor, The role of collaborative team-building in health care is increasingly recognized as a
T
means to ensure that patient care is timely, coordinated, patient-centered, and cost-effective
RI P
[1]. The Agency for Healthcare Research and Quality developed TeamSTEPPS, which teaches team members how to communicate and cooperate effectively through systemic
SC
training to reduce the possibility of medical errors, improve the prognosis of patients, and the satisfaction of hospital staff [2]. In 2010, the American Heart Association published new
MA NU
cardiopulmonary resuscitation guidelines stating that Advanced Cardiac Life Support (ACLS) should include training in teamwork [3]. Predefined ACLS scenarios that focus on teamwork with a high-fidelity simulator provide an opportunity for promoting interprofessional
ED
collaboration and a more realistic environment than does traditional ACLS mega-code training [4]. Because this topic is not discussed in the literature, we compared physicians and
PT
nurses undergoing ACLS training using teamwork-based high-fidelity simulation. This study was done in a 1200-bed university-affiliated medical center in Tainan. The
CE
simulation training was in the clinical-skill training center at our hospital. Meti iStan was the
AC
high-fidelity simulator. From May 2011 through Aug 2011, we held 49 sessions of ACLS training with teamwork-based high-fidelity simulation. All of the participants had previously undergone traditional ACLS mega-code training. We designed a one-hour training course that was close to our clinical situation. The training included (i) a Practice team that consisted of 1-3 residents being trained and 3 nurses being trained, and (ii) an Observation team that consisted of four observers (two physicians with an ACLS instructor license and two senior nurses). One physician recorded every important step on white board during the training. The two senior nurses checked every important step in detail using checklists for the “head area” and “chest area”. The other physician was in charge of the scenario. After the training, the four observers jointly conducted the debriefing (Figure 1).
ACCEPTED MANUSCRIPT Before the scenario, we did the orientation and introduced the environment and equipment. The purpose of the orientation, which took between 10 and 15 minutes, was to
T
quickly get the new participants to the point where they understood the individual team roles
RI P
and skills well enough to function as team members rather than unaffiliated individuals. Then we let the practice team practice using the equipment and got permission to record their
SC
performance. The practice team faced four critical conditions: unstable paroxysmal supraventricular tachycardia; asystole; pulseless ventricular tachycardia; and junctional
MA NU
bradycardia with shock. After the four scenarios, the training stopped, and the team was debriefed (Figure 1). The Observation team member who recorded the important points on the whiteboard led the debriefing, and the other three observers assisted. We discussed the
ED
facts, process, and procedure of resuscitation; and of teamwork and communication; and then we gave advice for this group and training session. After the training, all participants
PT
completed an anonymous evaluation of the program: participant background, learning, motivation, and satisfaction (Figure 1).
CE
All analyses were done using SPSS 16.0 for Windows (SPSS Inc, Chicago, IL, USA).
AC
Continuous data are presented as means ± SD. Comparisons between two groups were made using either an independent-samples t test (assuming normal distribution) or Mann-Whitney/Wilcoxon tests (assuming abnormal distribution) for the continuous variables. Either a 2 test or a Fisher's exact test was used for categorical variables. In total, 227 participants (87 physicians; 140 nurses) were enrolled for analysis; 1 participant was excluded because of insufficient data (Table 1). Both groups highly agreed that the learning and satisfaction were (nonsignificantly) better with teamwork-based high-fidelity simulation than with traditional ACLS mega-code training (Table 2). The topics best learned by physicians were when to use teamwork (94.3%); the technique of calling out (93.1%); and debriefing (92.0%), how to collaborate with other health professionals (92.0%),
ACCEPTED MANUSCRIPT and giving appropriate medical treatment (92.0%) (Table 2). The topics best learned by nurses were the technique of checking back (92.9%), how to collaborate with other health
T
professionals (92.1%), and determining the patient’s immediate clinical condition (91.4%)
RI P
(Table 2). Most participants were unit-assigned (69.9% vs. 65.4%, P = 0.635) (Table 3). Both groups had low motivation to participate in this training, especially the physicians (7.2% vs.
SC
24.3%, P = 0.001) (Table 3). Despite the high agreement about learning and satisfaction (Table 4), both groups had relatively low motivation to participate in similar training in the
MA NU
future (Table 2).
We found a high level of agreement between physicians and nurses that ACLS training with teamwork-based high-fidelity simulation was better and more efficacious than
ED
traditional ACLS mega-code training. We believe this training will improve patient care. Most of our participants were unit-assigned, not voluntary trainees, especially in the
PT
Physician group. In spite of their praise for the training, the members of both groups were relatively unmotivated in similar training activities in the future. This result may help us
AC
CE
redesign resuscitation training to make it more interesting and compelling.
ACCEPTED MANUSCRIPT
References 1.
DeVita MA, Braithwaite RS, Mahidhara R, Stuart S, Foraida M, Simmons RL, et al. Use
T
of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual
2.
Agency for healthcare research and quality. TeamSTEEPS. Retrieved Feb 16, 2014,
SC
from http://teamstepps.ahrq.gov/
Field JM, Hazinski MF, Sayre MR, et al. Part 1: executive summary: 2010 American Heart
MA NU
3.
RI P
Saf Health Care. 2004; 13: 251-254.
Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010; 122(18 Suppl 3): S640-S656. Dagnone JD, McGraw RC, Pulling CA, Patteson AK. Interprofessional resuscitation
CE
PT
ED
rounds: a teamwork approach to ACLS education. Med Teach. 2008; 30: e49-e54.
AC
4.
ACCEPTED MANUSCRIPT Table 1. Background of all participants Professional Status
Qualification
Number 87
T
Physician
RI P
1st-year Resident 2nd-year Resident
4th-year Resident
MA NU
Nurse
SC
3rd-year Resident
37 6 2 140 2
N1 (1-2 years working as a nurse)
18
N2 (2-3 years working as a nurse)
37
ED
N0 (< 1 year working as a nurse)
N3 (3-4 years working as a nurse)
34
N4 (4-5 years working as a nurse)
3
PT CE AC
N, nurse.
42
Team Leader
27
Head Nurse
6
Nurse Practitioner
8
Advanced Practitioner Nurse
5
ACCEPTED MANUSCRIPT
Table 2. Opinions from physicians and nurses about the comparative efficacy of ACLS training with teamwork-based high-fidelity simulation
PT
and traditional ACLS mega-code training
Nurses
(n = 87)
(n = 140)
CR I
Physicians
Items
P-
Neutral & disagree
Agree‡
Neutral & disagree
value
94.3 (82)
4.6 (4)
86.4 (121)
12.9 (18)
0.062
93.1 (81)
6.9 (6)
88.6 (124)
11.4 (16)
0.357
89.7 (78)
10.3 (9)
92.9 (130)
7.1 (10)
0.462
86.2 (75)
13.8 (12)
90.0 (126)
9.3 (13)
0.384
92.0 (80)
8.0 (7)
88.6 (124)
10.7 (15)
0.646
I now know more about how to collaborate with other health professionals*
92.0 (80)
8.0 (7)
92.1 (129)
7.9 (11)
0.236
I can more quickly determine the immediate clinical condition of a patient*
89.7 (78)
6.9 (6)
91.4 (128)
6.4 (9)
>0.95
I can more quickly give appropriate medical treatment to patients*
92.0 (80)
8.0 (7)
90.7 (127)
92.9 (13)
0.298
I will participate again if there are similar training activities
71.2 (62)
25.3 (22)
78.6 (110)
17.9 (25)
0.236
NU S
Agree‡
I have a better grasp of when to use teamwork*
MA
I have a better grasp of the technique of calling out*
D
I have a better grasp of the technique of checking back*
TE
I have a better grasp of the technique of the two-challenge rule*
AC
CE P
I have a better grasp of the technique of debriefing*
* ACLS training with teamwork-based high-fidelity simulation vs. traditional ACLS mega-code training ‡
Includes “agree” and “strongly agree”.
All data are percentage (number). Not all participants responded to all of the questionnaires. ACLS, Advanced Cardiac Life Support.
ACCEPTED MANUSCRIPT
9
ACLS with teamwork-based high-fidelity simulation
Table 3. Comparison of motivation between physicians and nurses in the ACLS training with
Physicians
Nurses
(n = 87)
(n = 140)
69.9 (58)
65.4 (89)
0.635
7.2 (6)
24.3 (33)
0.001
SC
teamwork-based high-fidelity simulation
< 0.001
Units Assigned Voluntary Work Demands
37.3 (31)
14.7 (20)
5.0 (5)
All data are percentage (number).
2.9 (4)
MA NU
Other
T
P-value
RI P
Motivation
AC
CE
PT
ED
ACLS, Advanced Cardiac Life Support.
9
0.309
ACCEPTED MANUSCRIPT
10
ACLS with teamwork-based high-fidelity simulation
Table 4. Comparison of satisfaction between physicians and nurses in the ACLS training with teamwork-based high-fidelity simulation Nurses
Item Do you think that:
(n = 140)
P-value
8.4 ± 1.3
0.762
8.6 ± 1.1
8.6 ± 1.2
0.780
8.3 ± 1.1
8.5 ± 1.2
0.144
8.5 ± 1.0
8.5 ± 1.2
0.867
8.4 ± 1.0
SC
this training activity will help patients?
(n = 87)
RI P
T
Physicians
this training activity helped you?
MA NU
this training activity will help your unit?
this training activity will help your hospital? All data are mean ± standard deviation.
AC
CE
PT
ED
ACLS, Advanced Cardiac Life Support.
10
ACCEPTED MANUSCRIPT ACLS with teamwork-based high-fidelity simulation
Figure Legend Figure 1. Flowchart of Advanced Cardiac Life Support training with teamwork-based
AC
CE
PT
ED
MA NU
SC
RI P
T
high-fidelity simulation.
11
11
ACCEPTED MANUSCRIPT
SC
RI P
T
ACLS with teamwork-based high-fidelity simulation
MA NU
Figure 1
Orientation (Environment, equipment, simulator)
ED
Start Scenario (One gets information and gives it to others)
2 Physician Observers (Record on whiteboard /Progress control)
AC
CE
PT
2 Senior Nurse Observers (head area/chest area)
Finish Scenario
Debriefing
Finish Self-assessment Sheet
12
12
S0735-6757(14)00350-7 doi: 10.1016/j.ajem.2014.05.027 YAJEM 54310
To appear in:
American Journal of Emergency Medicine
Received date: Revised date: Accepted date:
6 May 2014 19 May 2014 19 May 2014
Please cite this article as: Yang Tzu-Meng, Kao Yuan, Wang Chia-Ti, Chung Min-Hsien, Lin Hung-Jung, Lin Shio-Jean, How-Ran Guo M.D,.M.P.H,. ScD, Su Shih-Bin, Huang Chien-Cheng, Hsu Chien-Chin, Advanced Cardiac Life Support training: comparison of physicians and nurses with teamwork-based high-fidelity simulation, American Journal of Emergency Medicine (2014), doi: 10.1016/j.ajem.2014.05.027
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Advanced Cardiac Life Support training: comparison of physicians and nurses with teamwork-based high-fidelity simulation
T
Tzu-Meng Yang, MD1,+, Yuan Kao, MD1,+, Chia-Ti Wang, MD1, Min-Hsien Chung, MD1,2,
RI P
Hung-Jung Lin, MD, MBA1,3,4, Shio-Jean Lin, MD5, How-Ran Guo, MD, MPH, ScD6,7, Shih-Bin Su, MD, PhD8,9,10, Chien-Cheng Huang, MD1,11, Chien-Chin Hsu, MD, PhD1,4 Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
2
Department of Emergency Medicine, Chi-Mei Medical Center, Liouying, Tainan, Taiwan
3
Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
4
Department of Biotechnology, Southern Taiwan University of Science and Technology,
MA NU
SC
1
Tainan, Taiwan
Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan
6
Department of Environmental and Occupational Health, College of Medicine, National
ED
5
7
PT
Cheng Kung University, Tainan, Taiwan Department of Occupational and Environmental Medicine, National Cheng Kung University
CE
Hospital, Tainan, Taiwan
Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan
9
Department of Leisure, Recreation and Tourism Management, Southern Taiwan University
AC
8
of Science and Technology, Tainan, Taiwan 10
11
Department of Medical Research, Chi Mei Medical Center, Liouying, Tainan, Taiwan
Department of Child Care and Education, Southern Taiwan University of Science and
Technology, Tainan, Taiwan
Running title: ACLS with teamwork-based high-fidelity simulation +
These authors contributed equally to this work as first authors
ACCEPTED MANUSCRIPT Corresponding Authors: Chien-Cheng Huang, MD, Department of Emergency Medicine, Chi-Mei Medical Center,
T
901 Zhonghua Road, Yongkang District, Tainan City 710, Taiwan.
RI P
Tel: +886-6-281-2811; Fax: +886-6-281-6161; Email: [email protected] Chien-Chin Hsu, MD, PhD, Department of Emergency Medicine, Chi-Mei Medical Center,
SC
901 Zhonghua Road, Yongkang District, Tainan City 710, Taiwan.
Tel: +886-6-281-2811; Fax: +886-6-281-6161; Email: [email protected]
MA NU
Number of Tables: 4 Number of Figures: 1
AC
CE
PT
ED
Word counts: 799
ACCEPTED MANUSCRIPT To the Editor, The role of collaborative team-building in health care is increasingly recognized as a
T
means to ensure that patient care is timely, coordinated, patient-centered, and cost-effective
RI P
[1]. The Agency for Healthcare Research and Quality developed TeamSTEPPS, which teaches team members how to communicate and cooperate effectively through systemic
SC
training to reduce the possibility of medical errors, improve the prognosis of patients, and the satisfaction of hospital staff [2]. In 2010, the American Heart Association published new
MA NU
cardiopulmonary resuscitation guidelines stating that Advanced Cardiac Life Support (ACLS) should include training in teamwork [3]. Predefined ACLS scenarios that focus on teamwork with a high-fidelity simulator provide an opportunity for promoting interprofessional
ED
collaboration and a more realistic environment than does traditional ACLS mega-code training [4]. Because this topic is not discussed in the literature, we compared physicians and
PT
nurses undergoing ACLS training using teamwork-based high-fidelity simulation. This study was done in a 1200-bed university-affiliated medical center in Tainan. The
CE
simulation training was in the clinical-skill training center at our hospital. Meti iStan was the
AC
high-fidelity simulator. From May 2011 through Aug 2011, we held 49 sessions of ACLS training with teamwork-based high-fidelity simulation. All of the participants had previously undergone traditional ACLS mega-code training. We designed a one-hour training course that was close to our clinical situation. The training included (i) a Practice team that consisted of 1-3 residents being trained and 3 nurses being trained, and (ii) an Observation team that consisted of four observers (two physicians with an ACLS instructor license and two senior nurses). One physician recorded every important step on white board during the training. The two senior nurses checked every important step in detail using checklists for the “head area” and “chest area”. The other physician was in charge of the scenario. After the training, the four observers jointly conducted the debriefing (Figure 1).
ACCEPTED MANUSCRIPT Before the scenario, we did the orientation and introduced the environment and equipment. The purpose of the orientation, which took between 10 and 15 minutes, was to
T
quickly get the new participants to the point where they understood the individual team roles
RI P
and skills well enough to function as team members rather than unaffiliated individuals. Then we let the practice team practice using the equipment and got permission to record their
SC
performance. The practice team faced four critical conditions: unstable paroxysmal supraventricular tachycardia; asystole; pulseless ventricular tachycardia; and junctional
MA NU
bradycardia with shock. After the four scenarios, the training stopped, and the team was debriefed (Figure 1). The Observation team member who recorded the important points on the whiteboard led the debriefing, and the other three observers assisted. We discussed the
ED
facts, process, and procedure of resuscitation; and of teamwork and communication; and then we gave advice for this group and training session. After the training, all participants
PT
completed an anonymous evaluation of the program: participant background, learning, motivation, and satisfaction (Figure 1).
CE
All analyses were done using SPSS 16.0 for Windows (SPSS Inc, Chicago, IL, USA).
AC
Continuous data are presented as means ± SD. Comparisons between two groups were made using either an independent-samples t test (assuming normal distribution) or Mann-Whitney/Wilcoxon tests (assuming abnormal distribution) for the continuous variables. Either a 2 test or a Fisher's exact test was used for categorical variables. In total, 227 participants (87 physicians; 140 nurses) were enrolled for analysis; 1 participant was excluded because of insufficient data (Table 1). Both groups highly agreed that the learning and satisfaction were (nonsignificantly) better with teamwork-based high-fidelity simulation than with traditional ACLS mega-code training (Table 2). The topics best learned by physicians were when to use teamwork (94.3%); the technique of calling out (93.1%); and debriefing (92.0%), how to collaborate with other health professionals (92.0%),
ACCEPTED MANUSCRIPT and giving appropriate medical treatment (92.0%) (Table 2). The topics best learned by nurses were the technique of checking back (92.9%), how to collaborate with other health
T
professionals (92.1%), and determining the patient’s immediate clinical condition (91.4%)
RI P
(Table 2). Most participants were unit-assigned (69.9% vs. 65.4%, P = 0.635) (Table 3). Both groups had low motivation to participate in this training, especially the physicians (7.2% vs.
SC
24.3%, P = 0.001) (Table 3). Despite the high agreement about learning and satisfaction (Table 4), both groups had relatively low motivation to participate in similar training in the
MA NU
future (Table 2).
We found a high level of agreement between physicians and nurses that ACLS training with teamwork-based high-fidelity simulation was better and more efficacious than
ED
traditional ACLS mega-code training. We believe this training will improve patient care. Most of our participants were unit-assigned, not voluntary trainees, especially in the
PT
Physician group. In spite of their praise for the training, the members of both groups were relatively unmotivated in similar training activities in the future. This result may help us
AC
CE
redesign resuscitation training to make it more interesting and compelling.
ACCEPTED MANUSCRIPT
References 1.
DeVita MA, Braithwaite RS, Mahidhara R, Stuart S, Foraida M, Simmons RL, et al. Use
T
of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual
2.
Agency for healthcare research and quality. TeamSTEEPS. Retrieved Feb 16, 2014,
SC
from http://teamstepps.ahrq.gov/
Field JM, Hazinski MF, Sayre MR, et al. Part 1: executive summary: 2010 American Heart
MA NU
3.
RI P
Saf Health Care. 2004; 13: 251-254.
Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010; 122(18 Suppl 3): S640-S656. Dagnone JD, McGraw RC, Pulling CA, Patteson AK. Interprofessional resuscitation
CE
PT
ED
rounds: a teamwork approach to ACLS education. Med Teach. 2008; 30: e49-e54.
AC
4.
ACCEPTED MANUSCRIPT Table 1. Background of all participants Professional Status
Qualification
Number 87
T
Physician
RI P
1st-year Resident 2nd-year Resident
4th-year Resident
MA NU
Nurse
SC
3rd-year Resident
37 6 2 140 2
N1 (1-2 years working as a nurse)
18
N2 (2-3 years working as a nurse)
37
ED
N0 (< 1 year working as a nurse)
N3 (3-4 years working as a nurse)
34
N4 (4-5 years working as a nurse)
3
PT CE AC
N, nurse.
42
Team Leader
27
Head Nurse
6
Nurse Practitioner
8
Advanced Practitioner Nurse
5
ACCEPTED MANUSCRIPT
Table 2. Opinions from physicians and nurses about the comparative efficacy of ACLS training with teamwork-based high-fidelity simulation
PT
and traditional ACLS mega-code training
Nurses
(n = 87)
(n = 140)
CR I
Physicians
Items
P-
Neutral & disagree
Agree‡
Neutral & disagree
value
94.3 (82)
4.6 (4)
86.4 (121)
12.9 (18)
0.062
93.1 (81)
6.9 (6)
88.6 (124)
11.4 (16)
0.357
89.7 (78)
10.3 (9)
92.9 (130)
7.1 (10)
0.462
86.2 (75)
13.8 (12)
90.0 (126)
9.3 (13)
0.384
92.0 (80)
8.0 (7)
88.6 (124)
10.7 (15)
0.646
I now know more about how to collaborate with other health professionals*
92.0 (80)
8.0 (7)
92.1 (129)
7.9 (11)
0.236
I can more quickly determine the immediate clinical condition of a patient*
89.7 (78)
6.9 (6)
91.4 (128)
6.4 (9)
>0.95
I can more quickly give appropriate medical treatment to patients*
92.0 (80)
8.0 (7)
90.7 (127)
92.9 (13)
0.298
I will participate again if there are similar training activities
71.2 (62)
25.3 (22)
78.6 (110)
17.9 (25)
0.236
NU S
Agree‡
I have a better grasp of when to use teamwork*
MA
I have a better grasp of the technique of calling out*
D
I have a better grasp of the technique of checking back*
TE
I have a better grasp of the technique of the two-challenge rule*
AC
CE P
I have a better grasp of the technique of debriefing*
* ACLS training with teamwork-based high-fidelity simulation vs. traditional ACLS mega-code training ‡
Includes “agree” and “strongly agree”.
All data are percentage (number). Not all participants responded to all of the questionnaires. ACLS, Advanced Cardiac Life Support.
ACCEPTED MANUSCRIPT
9
ACLS with teamwork-based high-fidelity simulation
Table 3. Comparison of motivation between physicians and nurses in the ACLS training with
Physicians
Nurses
(n = 87)
(n = 140)
69.9 (58)
65.4 (89)
0.635
7.2 (6)
24.3 (33)
0.001
SC
teamwork-based high-fidelity simulation
< 0.001
Units Assigned Voluntary Work Demands
37.3 (31)
14.7 (20)
5.0 (5)
All data are percentage (number).
2.9 (4)
MA NU
Other
T
P-value
RI P
Motivation
AC
CE
PT
ED
ACLS, Advanced Cardiac Life Support.
9
0.309
ACCEPTED MANUSCRIPT
10
ACLS with teamwork-based high-fidelity simulation
Table 4. Comparison of satisfaction between physicians and nurses in the ACLS training with teamwork-based high-fidelity simulation Nurses
Item Do you think that:
(n = 140)
P-value
8.4 ± 1.3
0.762
8.6 ± 1.1
8.6 ± 1.2
0.780
8.3 ± 1.1
8.5 ± 1.2
0.144
8.5 ± 1.0
8.5 ± 1.2
0.867
8.4 ± 1.0
SC
this training activity will help patients?
(n = 87)
RI P
T
Physicians
this training activity helped you?
MA NU
this training activity will help your unit?
this training activity will help your hospital? All data are mean ± standard deviation.
AC
CE
PT
ED
ACLS, Advanced Cardiac Life Support.
10
ACCEPTED MANUSCRIPT ACLS with teamwork-based high-fidelity simulation
Figure Legend Figure 1. Flowchart of Advanced Cardiac Life Support training with teamwork-based
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CE
PT
ED
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SC
RI P
T
high-fidelity simulation.
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ACCEPTED MANUSCRIPT
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RI P
T
ACLS with teamwork-based high-fidelity simulation
MA NU
Figure 1
Orientation (Environment, equipment, simulator)
ED
Start Scenario (One gets information and gives it to others)
2 Physician Observers (Record on whiteboard /Progress control)
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CE
PT
2 Senior Nurse Observers (head area/chest area)
Finish Scenario
Debriefing
Finish Self-assessment Sheet
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