Medical Simulation Center
Research Interests, Projects and Grants
 In 1995 Rhode Island Hospital was chosen as a site for "MedTeams,"
a multi-center military and civilian research project to study the
implementation of a teamwork curriculum in the emergency center.
MedTeams is a system of teamwork training and organizational
change that focuses on behavioral solutions to the problem of patient
safety and to the delivery of improved patient care. Based on a
set of teamwork principles that are widely used in crew resource
management (CRM) programs in military and commercial aviation, MedTeams
is now being implemented as a performance and safety solution in
emergency care.
Despite coming from an environment associated with sophisticated
technology, MedTeams is not a technological solution. The coordination
and communication teamwork behaviors it teaches support individual
performance and error management at the team level. MedTeams meets
the requirement for teamwork in healthcare that has been addressed
in medical publications and specifically recognized in the Institute
of Medicine's 1999 report on errors in medicine (Recommendation
8.1 and Principle 3).
A prospective investigation of the training intervention was conducted
from May 1998 to March 1999 using a quasi-experimental, untreated
control group design with one pretest and two posttests. Nine hospital
emergency departments were assigned to experimental and control
groups. Six hospitals were allocated to the experimental group to
allow for civilian-military and teaching-community setting variations.
Control EDs agreed to delay training, which precluded evaluation
of their intervention.
Five of the hospitals were civilian and four were military; five
were teaching and four were community hospitals. A total of 684
physicians, nurses and technicians were trained in the experimental
group and 374 physicians, nurses, and technicians were trained in
the control group. Three outcome constructs were assessed: team
behaviors, attitudes and opinions, and ED performance.
The results, details of which may be found in Morey et al., demonstrated the effectiveness of the MedTeams system. Improvements
were obtained in the experimental group for six out of the seven
key measures assessed. The quality of team behaviors improved, workload
was not increased by practicing teamwork, staff attitudes towards
teamwork were enhanced, preparation of patients for admission from
the ED improved, and the proportion of highly satisfied patients
increased.
The most important finding from the validation was that
clinical errors were substantially and significantly reduced. A
clinical error was defined as any clinical task that actually or
potentially put a patient at risk. These errors were witnessed by
a specially trained emergency center nurse or physician observing cases for the
purpose of rating teamwork behaviors.
An example of a reported error occurred during a resuscitation.
A burn patient received duplicate administrations of intravenous
morphine when two nurses independently administered the drug after
a physician gave a verbal order. The staff recognized the overdose
when the patient's breathing slowed, at which point they intervened
and the patient recovered. A check-back for a verbal medical order,
a teamwork behavior taught in MedTeams, would have avoided or "captured"
this error.
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