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Award winning project incorporates team based working into medical simulation

Hywel Dda University Health Board – 2014

It’s a winner! Hywel Dda’s innovative integration of team working principles into a medical simulation programme for nurses and junior doctors has had a significant impact on patient outcomes in acute adult general wards.


Why Team Based Working?
Suffer a cardiac arrest in hospital and your chance of eventual discharge is just 13.5%. Four in five of these cardiac arrests are predictable with patients showing early warning signs up to 12 hours in advance. As a result, clinical education programmes have long focused on improving skills, not just in resuscitation but also in recognising and responding to the deteriorating patient.

More recently however, evidence has highlighted the importance of supplementing technical competence with effective team working and human factor principles to improve patient outcomes.

Hywel Dda had seen a rapid decline in cardiac arrest rates on the general ward area within one hospital, but in 2011 the rates increased. Sian Hall, Lead for Resuscitation and Simulation, saw the potential for improving team working. Whilst all resuscitation literature covered effective teamwork to some degree, she believed that the core principles of AOD Team Based Working offered the best structure to improve multi-professional team working around cardiac arrest.

The approach
Sian’s team proposed to adapt the mandatory Immediate Life Support course to incorporate Team Based Working and Hywel Dda’s Resuscitation Committee agreed to pilot the revised course within one hospital.

Training brought together multi-professional ward-based teams of support workers, registered nursing staff and junior doctors in a single session.

The core principles of team identity, common objectives, role clarity and value of feedback were covered within the Rapid Response to Acute Illness Learning Set (RRAILS) and human factors theory sessions. Ward based simulation scenarios were used to encourage appropriate teamwork behaviours and provide opportunities for reflective discussions. All scenarios matched the knowledge and skills framework and the deanery core curriculum.

Participant evaluation forms were developed, training attendance was recorded and cardiac arrest activity was monitored monthly.

The results
To date there has been a significant decrease in the incidence of cardiac arrest calls from the general ward areas:

Year 2009 2010 2011 2012 2013
Number of cardiac arrests 28 23 25 21 15


On the back of the 2012 results, the Resuscitation Committee agreed to start the programme in a second acute hospital. This course was started in January 2013 and there are early signs that cardiac arrest rates have started to decline. There are plans to extend the original programme to the remaining two acute hospitals within the Health Board.

Resuscitation team leads recognised that feedback and reflection among the clinical staff following incidents proved a powerful learning process in changing behaviours. They went on to develop clinical educators in other specialities, including a multi-professional programme in obstetrics which began in 2013.

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