Does Medical Simulation and Team Training Improve Patient Outcomes?

Since mid 1990's, healthcare simulation has incorporated team training to improve patient safety, building on lessons learned from the aviation industry. Programs like Crew Resource Management (CRM), first introduced by NASA, were added to Undergraduate and Graduate medical training in the early 2000’s, focusing on the need for teamwork and improved communication. By 2009, “the AAMC, along with five other associations representing health professions schools, created the Interprofessional Education Collaborative (IPEC) to advance interprofessional education (IPE).”¹

While it is imperative to recognize the wonderful safety record of the aviation industry, comparing it to the healthcare environment does not account for the many non-standardized human elements involved in caring for sick patients with very individualized needs.  

As the science of healthcare simulation continues to mature, researchers are looking closer to see if team training, practiced either in a simulation learning center or in-situ, transfers to real clinical situations and measurably improves patient outcomes.

As there are generally many factors involved in patient care, it is often difficult to ascertain whether a simulation program, in and of itself, is the main contributing factor to improved patient outcomes. A meta-analysis published in 2019² looked at the relationship between teamwork and performance. The results showed that “teamwork is positively related to performance…regardless of the characteristics of the team or task” and implores healthcare organizations to “recognize the value of teamwork and emphasize approaches that maintain and improve teamwork for the benefit of their patients.”

While most publications that focus on teamwork say that there “may” be some positive feelings and potential for better results related to team training, most fall short of showing measurable improvements in patient outcomes. There are, however, a few stories that show improved outcomes for patients that are convincingly resultant from simulation based team training. The following is a summary of two studies with measurable results:

• Obstetric emergencies are frightening for everyone involved, including the parents, family, staff, and the provider delivering the infant. Through sustained training over more than 12 years, the Practical Obstetric Multi-Professional Training (PROMPT) program in England has been able to show improved outcomes as well as Return on Investment (ROI), and significant cost savings to the National Health Service (NHS).
  • The latest study from this group published in 2021 aimed to “determine the cost-utility of a multi-professional simulation training programme for obstetric emergencies…with a particular focus on its impact on permanent obstetric brachial plexus injuries (OBPIs).”³
    • Results show not only a decrease of OBPIs to 0% (over 12 years), but also a nationwide cost savings over more than one billion dollars.³
  • As with most emergencies, timing is crucial in diagnosing and providing the correct treatment for stroke victims. A German study published in 2021 by Bohmann et. al⁵ reported a 5-minute reduction in time from admission to intravenous thrombolysis and a 21-minute reduction in the time from admission to endovascular therapy when treated by “simulation-experienced stroke teams.”

In reviewing the literature on patient simulation team training, one thing that continues to stand out is the need for sustained training “over a number of years.”³ This kind of sustained training requires ongoing funding to see actual improvements in patient outcomes. Ghag et. al (2021) conducted a qualitative study to determine what key components needed to be in place to effectively sustain training:⁴

• Local champions who are motivated, committed and have influence within hospital administration
• Multi-level organizational involvement within and from outside the hospital
• A willingness to address organizational challenges including application of training, staff turnover, cost, and training attendance.⁴

Limbs & Things has been a strong proponent of team training since its early collaboration with the Southmead Hospital faculty and staff on the Birthing Simulator, PROMPT in the early 2000’s. Now in its second generation, the improved  Birthing Simulation - PROMPT Flex range includes modules that aid in individual and team training for the following obstetric scenarios:

• Cervical Dilatation and Effacement
• Cervical Cerclage
• Normal delivery
• Post-Partum Hemorrhage (Maternal Hemorrhage or PPH)
• Compression suture
• Shoulder Dystocia
• C-Section Delivery and Impacted Fetal Head
• Breech delivery
• Operative delivery with forceps or vacuum extractor
• Cord Prolapse

If you are interested in knowing more about our hybrid products geared toward team training and patient communication using a Simulated Patient, don’t hesitate to reach out to a member of our team for a demonstration, either virtually or in person.

¹ AAMC Website: Interprofessional Education

² How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic review and meta-analysis

³ A model-based cost-utility analysis of multi-professional simulation training in obstetric emergencies

⁴ Key components influencing the sustainability of a multi-professional obstetric emergencies training programme in a middle-income setting: a qualitative study

⁵ Simulation-based training improves process times in acute stoke care (STREAM)