Postgraduate simulation within a hospital setting, with a focus on crisis resource management and team training, in acute care paediatrics : where are we and where should we be?
Degree GrantorUniversity of Canterbury
Degree NameMaster of Health Sciences
The intention of this thesis is to present information relating to the use of interprofessional simulation team training or crisis resource management in the area of postgraduate training for those health professionals involved in acute paediatric care. The initial stimuli for this review came from two areas; an increasing understanding of the challenges of providing paediatric intensive care within the Canterbury District Health Board (CDHB) as well as the wider context of the South Island of New Zealand and a belief that appropriately targeted interprofessional simulation education could contribute to improved organizational culture and improved patient care. The final trigger can be considered as the death of a young infant who required paediatric intensive care. Her death may not have been avoidable but as a clinician involved with the case I, and many others, were moved to consider aspects of our healthcare in which improvements could be made. I believe that the efficient embedding of effective simulation clinical training is a core part of providing improvements in healthcare for the following reasons that will be elaborated on within this thesis: • Continued quality improvement in the knowledge, skills and service-based application requires a recognition that it is not about the provision of service being in conflict with attendance at educational sessions but about both being necessary and complementary. • Simulation of clinical scenarios provides the opportunity for regular practice of the core skills of individuals such that they become as automatic as driving a car, and as a result do not require significant cognitive energy input. • Simulation of clinical scenarios also provides the opportunity to practice those skills that are vital in specific situations but are rarely encountered within the workplace. It begins an individual’s cognitive preparation for the rare event. • Regular department and team simulation enables the development of communication skills, with standardisation of communication processes and a common language, to enhance the efficiency and minimize the effect of bias, assumptions and misunderstandings. • The skills of ‘teaming’ are modeled within the clinical simulation and within the workplace by faculty leading simulation. • The combination of clinical simulation with expert debriefing provides an opportunity to discuss processes that need improvement and the running of simulation within the workplace may highlight previously unrecognized latent errors within the system.