Simulation-Debriefing Enhanced Needs Assessment to Address Quality Markers in Health Care: An Innovation for Prospective Hazard Analysis.

Simulation-Debriefing Enhanced Needs Assessment (SDENA) is a simulation-based approach to prospective hazard analysis that uses simulation and debriefing as a unit-level diagnostic tool. Scenarios address failure modes for health care improvement targets, and debriefing explores unit-specific barriers and resiliencies. Debriefing guides are structured to explore how six drivers of a behavior engineering framework (data, tools/resources, incentives, knowledge/skills, capacity, motivation) influence clinical behaviors.

Mitigation of SARS-CoV-2 transmission at a large public university.

In Fall 2020, universities saw extensive transmission of SARS-CoV-2 among their populations, threatening health of the university and surrounding communities, and viability of in-person instruction. Here we report a case study at the University of Illinois at Urbana-Champaign, where a multimodal "SHIELD: Target, Test, and Tell" program, with other non-pharmaceutical interventions, was employed to keep classrooms and laboratories open. The program included epidemiological modeling and surveillance, fast/frequent testing using a novel low-cost and scalable saliva-based RT-qPCR assay for SARS-CoV-2 that bypasses RNA extraction, called covidSHIELD, and digital tools for communication and compliance.

In Situ Simulation for Adoption of New Technology to Improve Sepsis Care in Rural Emergency Departments.

Objectives: The aims of the study were to evaluate whether in situ (on-site) simulation training is associated with increased telemedicine use for patients presenting to rural emergency departments (EDs) with severe sepsis and septic shock and to evaluate the association between simulation training and telehealth with acute sepsis bundle (SEP-1) compliance and mortality.

Methods: This was a quasi-experimental study of patients presenting to 2 rural EDs with severe sepsis and/or septic shock before and after rollout of in situ simulation training that included education on sepsis management and the use of telehealth. Unadjusted and adjusted analyses were conducted to describe the association of simulation training with sepsis process of care markers and with mortality.

There's an app for that: Teaching residents to communicate diagnostic uncertainty through a mobile gaming application.

Background: Clear communication is integral to good clinical care; however, communication training is cost and time intensive. Mobile applications (apps) may provide a useful adjunct to traditional simulation skills training.

Objective: To evaluate (1) use of an app for teaching communication skills about diagnostic uncertainty, (2) feedback on app use, and (3) the association between use and skill mastery.

Access to Care: End-to-End Digital Response for COVID-19 Care Delivery.

The coronavirus disease 2019 pandemic disrupted health care, requiring organizational leaders to act quickly to manage the health-related concerns of individuals and communities. The ability to offer a variety of digitally enabled telehealth services with 24/7 access to nurse practitioners and physician assistants allowed us to care for patients in their homes. It reduced the spread of the virus, protected our employees from further disease spread, and provided early interventions to those in need.

A novel in situ simulation framework for introduction of a new technology: the 3-Act-3-Debrief model.

Background: New technologies for clinical staff are typically introduced via an "in-service" that focuses on knowledge and technical skill. Successful adoption of new healthcare technologies is influenced by multiple other factors as described by the Consolidated Framework in Implementation Research (CFIR). A simulation-based introduction to new technologies provides opportunity to intentionally address specific factors that influence adoption.

The Equivalence of Video Self-review Versus Debriefing After Simulation: Can Faculty Resources Be Reallocated?

Introduction: Traditional simulation debriefing is both time- and resource-intensive. Shifting the degree of primary learning responsibility from the faculty to the learner through self-guided learning has received greater attention as a means of reducing this resource intensity. The aim of the study was to determine if video-assisted self-debriefing, as a form of self-guided learning, would have equivalent learning outcomes compared to standard debriefing.

A Simple Low-Cost Method to Integrate Telehealth Interprofessional Team Members During In Situ Simulation.

Introduction: With the growth of telehealth, simulation personnel will be called upon to support training that integrates these new technologies and processes. We sought to integrate remote telehealth electronic intensive care unit (eICU) personnel into in situ simulations with rural emergency department (ED) care teams. We describe how we overcame technical challenges of creating shared awareness of the patient's condition and the care team's progress among those executing the simulation, the care team, and the eICU.

Clinician behaviors in telehealth care delivery: a systematic review.

Literature on telehealth care delivery often addresses clinical, cost, technological, system, and organizational impacts. Less is known about interpersonal behaviors such as communication patterns and therapeutic relationship-building, which may have workforce development considerations. The purpose of this study was to conduct a systematic literature review to identify interpersonal health care provider (HCP) behaviors and attributes related to provider-patient interaction during care in telehealth delivery.

Testing of the Patients' Insights and Views of Teamwork (PIVOT) Survey: a validity study.

Objective: To explore patient observations of teamwork-related behaviors such as inter-team communication through a newly designed survey.

Methods: In this cross-sectional study, 101 patients (N=86) and caregivers (N=15) recruited from the emergency department (ED) of an urban, academic medical center (>85,000 visits/year) completed the 16-item Patients' Insights and Views Observing Teams (PIVOT) Survey. We evaluated validity evidence through descriptive statistics and analysis including a Many-facet Rasch model to determine associations between questionnaire items and sociodemographic characteristics.

Implementation of unit-based interventions to improve teamwork and patient safety on a medical service.

In a prior study involving 2 medical units, Structured Interdisciplinary Rounds (SIDRs) improved teamwork and reduced adverse events (AEs). SIDR was implemented on 5 additional units, and a pre- versus postintervention comparison was performed. SIDR combined a structured format for communication with daily interprofessional meetings.

Failure mode effects and criticality analysis: innovative risk assessment to identify critical areas for improvement in emergency department sepsis resuscitation.

Background: Sepsis is an increasing problem in the practice of emergency medicine as the prevalence is increasing and optimal care to reduce mortality requires significant resources and time. Evidence-based septic shock resuscitation strategies exist, and rely on appropriate recognition and diagnosis, but variation in adherence to the recommendations and therefore outcomes remains. Our objective was to perform a multi-institutional prospective risk-assessment, using failure mode effects and criticality analysis (FMECA), to identify high-risk failures in ED sepsis resuscitation.

Specialty milestones and the next accreditation system: an opportunity for the simulation community.

The Accreditation for Graduate Medical Education has developed a new process of accreditation, the Next Accreditation System (NAS), which focuses on outcomes. A key component of the NAS is specialty milestones-specific behavior, attributes, or outcomes within the general competency domains. Milestones will mark a level of proficiency of a resident within a competency domain.

Patients' views of teamwork in the emergency department offer insights about team performance.

Background: Research into efforts to engage patients in the assessment of health-care teams is limited.

Objective: To explore, through qualitative methods, patient awareness of teamwork-related behaviours observed during an emergency department (ED) visit.

Design: Researchers used semi-structured question guides for audio-recorded interviews and analysed their verbatim transcripts.

A new tool for testing and training ophthalmoscopic skills.

Introduction: The direct fundoscopic examination is an important clinical skill, yet the examination is difficult to teach and competency is difficult to assess. Currently there is no defined proficiency assessment for this physical examination, and the objective of this study was to assess the feasibility of a simulation model for evaluating the fundoscopic skills of residents.

Methods: Emergency medicine and ophthalmology residents participated in simulation sessions using a commercially available eye simulator that was modified with customized slides.

Simulation-based education with mastery learning improves paracentesis skills.

Background: Paracentesis is a commonly performed bedside procedure that has the potential for serious complications. Therefore, simulation-based education for paracentesis is valuable for clinicians.

Objective: To assess internal medicine residents' procedural skills before and after simulation-based mastery learning on a paracentesis simulator.

Language use in the informed consent discussion for emergency procedures.

Background: The field of health literacy has closely examined the readability of written health materials to optimize patient comprehension. Few studies have examined spoken communication in a way that is comparable to analyses of written communication.

Purpose: The study objective was to characterize the structural elements of residents' spoken words while obtaining informed consent.

Melanoma trainer using simulated back skin: an innovative design.

Introduction: The method used to create a melanoma trainer using simulated back skin is presented. The trainer is intended to be used to teach medical students to identify benign and malignant cutaneous pigmented lesions.

Methods: Non-Hispanic and Hispanic white melanoma trainers were created using flexible polyurethane foam and pigmented silicone rubber.

Self-reported use of communication techniques in the emergency department.

Background: Communication is considered a core competency for physicians. However, the Emergency Department setting poses significant and unique communication challenges.

Objective: The objective of this study was to explore self-reported use and perceptions of effectiveness and feasibility of communication techniques used by Emergency Physicians for communication with patients.

Is it the athlete or the equipment? An analysis of the top swim performances from 1990 to 2010.

O'Connor, LM and Vozenilek, JA. Is it the athlete or the equipment? An analysis of the top swim performances from 1990 to 2010. J Strength Cond Res 25(12): 3239-3241, 2011-Forty-three world record swims were recorded at the 2009 Fédération Internationale de Natation (FINA) World Championship meet in Rome.

Comparison of checklist and anchored global rating instruments for performance rating of simulated pediatric emergencies.

Purpose: To compare the psychometric performance of two rating instruments used to assess trainee performance in three clinical scenarios.

Methods: This study was part of a two-phase, randomized trial with a wait-list control condition assessing the effectiveness of a pediatric emergency medicine curriculum targeting general emergency medicine residents. Residents received 6 hours of instruction either before or after the first assessment.

Simulation center accreditation and programmatic benchmarks: a review for emergency medicine.

Simulation-based education has grown significantly over the past 10 years. As a result, more professional organizations are developing or implementing accreditation processes to help define minimum standards and best practices in simulation-based training. However, the benefits and potential pitfalls of sponsoring and implementing such programs have yet to be fully evaluated across specialties.

Improving handoffs in the emergency department.

Patient handoffs at shift change are a ubiquitous and potentially hazardous process in emergency care. As crowding and lengthy evaluations become the standard for an increasing proportion of emergency departments (EDs), the number of patients handed off will likely increase. It is critical now more than ever before to ensure that handoffs supply valid and useful shared understandings between providers at transitions of care.

Development and evaluation of a simulation-based pediatric emergency medicine curriculum.

Purpose: The infrequency of severe childhood illness limits opportunities for emergency medicine (EM) providers to learn from real-world experience. Simulation offers an evidence-based educational approach to develop and practice clinical skills.

Method: This was a two-phase, randomized trial with a wait-list control condition.