"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."

Margaret Mead
Original article
peer-reviewed

Using Simulated Transport Calls to Identify Diversity of Knowledge and Care Plans among the Multidisciplinary Team



Abstract

Research has shown that patient safety and quality of care provided is affected by the knowledge, technical ability, and behavioral skills of each member of the multidisciplinary care team. All NICU patients at Boston Children’s Hospital (BCH) are born at outside facilities. Thus, transport call preparedness is fundamental to providing exceptional care for NICU patients. Our study aims to answer the question: Does significant variance exist among the multidisciplinary team members in the interpretation of transport call data and the subsequent preparation that occurs when caring for critically ill neonates?

The 2011 NICU Crisis Resource Management (CRM) course reflects results from a multidisciplinary needs assessment. Three transport calls for neonate with persistent pulmonary hypertension of the newborn (PPHN) were received by a multidisciplinary team. Each member completed a survey following each call. After the final transport call, the patient arrived in the simulator suite and the course progressed.

One hundred forty interdisciplinary participants completed the course. After listening to the transport calls, 85.5% of participants categorized the patient as category, RED (Emergent/Urgent resuscitation-high acute status), while 14.5% of participants selected category, YELLOW (Patient in clinical transition or requiring time sensitive procedures). Of the healthcare providers, the highest percentage group selecting category YELLOW was the fellow group (18%), while 0% of the NNP group selected YELLOW. Blood pressure mean goal recommendations were more varied among the groups. Eighty-five per cent of attendings, 75% of neonatal nurse practitioners (NNPs), 75% of fellows, and 55% of RNs selected 40-50 mmHg; while 15% of attendings, 25% of NNPs, 12.5% of fellows, and 33% of RNs selected 50 mmHg or more. Importantly, 100% of participants, including attendings, NNPs, respiratory therapists (RTs), fellows, and RNs, said they would have a team “huddle” prior to the arrival of this infant.

Within the variance that exists in regard to knowledge, experience, and practice among the multidisciplinary groups, attendings and NNPs tended to be more aligned with their assessment and approach. Simulated transport calls provide a safe environment to uncover these differences and to allow for future study to improve teamwork and to provide the best care for the critically ill neonate.



Want to read more?

Create a free account to continue reading this article.

Already a member? Login.



Original article
peer-reviewed

Using Simulated Transport Calls to Identify Diversity of Knowledge and Care Plans among the Multidisciplinary Team


Author Information

Elizabeth Doherty Corresponding Author

Newborn Medicine, Boston Children's Hospital

Christine Rachwal

Newborn Medicine, Boston Children's Hospital

Kristen Lindamood

Newborn Medicine, Boston Children's Hospital

Caitlin O'Brien

Newborn Medicine, Boston Children's Hospital

Peter Weinstock

Anesthesia and Critical Care Medicine, Boston Children's Hospital


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. BCH issued approval IRB-P00002103
The following protocol was considered exempt from IRB/human subject review on 12/8/2011. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.

Acknowledgements

Denise Casey, RN, MS, CCNP, CCRN (Boston Children’s Hospital, Harvard Medical School) Denise.Casey@childrens.harvard.edu Michelle DeGrazia, PhD, RN, NNP-BC (Boston Children's Hospital, Harvard Medical School) Michele.DeGrazia@childrens.harvard.edu Monica Kleinman, MD (Clinical Director, Medical/Surgical Intensive Care Unit; Medical Director, Transport Program, Boston Children’s Hospital; Associate Professor of Anesthesia, Harvard Medical School) Monica.Kleinman@childrens.harvard.edu


Original article
peer-reviewed

Using Simulated Transport Calls to Identify Diversity of Knowledge and Care Plans among the Multidisciplinary Team


Figures etc.

Share
Original article
peer-reviewed

Using Simulated Transport Calls to Identify Diversity of Knowledge and Care Plans among the Multidisciplinary Team

  • Author Information
    Elizabeth Doherty Corresponding Author

    Newborn Medicine, Boston Children's Hospital

    Christine Rachwal

    Newborn Medicine, Boston Children's Hospital

    Kristen Lindamood

    Newborn Medicine, Boston Children's Hospital

    Caitlin O'Brien

    Newborn Medicine, Boston Children's Hospital

    Peter Weinstock

    Anesthesia and Critical Care Medicine, Boston Children's Hospital


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. BCH issued approval IRB-P00002103
    The following protocol was considered exempt from IRB/human subject review on 12/8/2011. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements

    Denise Casey, RN, MS, CCNP, CCRN (Boston Children’s Hospital, Harvard Medical School) Denise.Casey@childrens.harvard.edu Michelle DeGrazia, PhD, RN, NNP-BC (Boston Children's Hospital, Harvard Medical School) Michele.DeGrazia@childrens.harvard.edu Monica Kleinman, MD (Clinical Director, Medical/Surgical Intensive Care Unit; Medical Director, Transport Program, Boston Children’s Hospital; Associate Professor of Anesthesia, Harvard Medical School) Monica.Kleinman@childrens.harvard.edu


    Article Information

    Published: October 09, 2014

    DOI

    10.7759/cureus.217

    Cite this article as:

    Doherty E, Rachwal C, Lindamood K, et al. (October 09, 2014) Using Simulated Transport Calls to Identify Diversity of Knowledge and Care Plans among the Multidisciplinary Team. Cureus 6(10): e217. doi:10.7759/cureus.217

    Publication history

    Received by Cureus: September 20, 2014
    Peer review began: September 22, 2014
    Peer review concluded: October 08, 2014
    Published: October 09, 2014

    Copyright

    © Copyright 2014
    Doherty et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Research has shown that patient safety and quality of care provided is affected by the knowledge, technical ability, and behavioral skills of each member of the multidisciplinary care team. All NICU patients at Boston Children’s Hospital (BCH) are born at outside facilities. Thus, transport call preparedness is fundamental to providing exceptional care for NICU patients. Our study aims to answer the question: Does significant variance exist among the multidisciplinary team members in the interpretation of transport call data and the subsequent preparation that occurs when caring for critically ill neonates?

The 2011 NICU Crisis Resource Management (CRM) course reflects results from a multidisciplinary needs assessment. Three transport calls for neonate with persistent pulmonary hypertension of the newborn (PPHN) were received by a multidisciplinary team. Each member completed a survey following each call. After the final transport call, the patient arrived in the simulator suite and the course progressed.

One hundred forty interdisciplinary participants completed the course. After listening to the transport calls, 85.5% of participants categorized the patient as category, RED (Emergent/Urgent resuscitation-high acute status), while 14.5% of participants selected category, YELLOW (Patient in clinical transition or requiring time sensitive procedures). Of the healthcare providers, the highest percentage group selecting category YELLOW was the fellow group (18%), while 0% of the NNP group selected YELLOW. Blood pressure mean goal recommendations were more varied among the groups. Eighty-five per cent of attendings, 75% of neonatal nurse practitioners (NNPs), 75% of fellows, and 55% of RNs selected 40-50 mmHg; while 15% of attendings, 25% of NNPs, 12.5% of fellows, and 33% of RNs selected 50 mmHg or more. Importantly, 100% of participants, including attendings, NNPs, respiratory therapists (RTs), fellows, and RNs, said they would have a team “huddle” prior to the arrival of this infant.

Within the variance that exists in regard to knowledge, experience, and practice among the multidisciplinary groups, attendings and NNPs tended to be more aligned with their assessment and approach. Simulated transport calls provide a safe environment to uncover these differences and to allow for future study to improve teamwork and to provide the best care for the critically ill neonate.



Want to read more?

Create a free account to continue reading this article.

Already a member? Login.



Elizabeth Doherty

Newborn Medicine, Boston Children's Hospital

For correspondence:
elizabeth.doherty@childrens.harvard.edu

Christine Rachwal

Newborn Medicine, Boston Children's Hospital

Kristen Lindamood

Newborn Medicine, Boston Children's Hospital

Caitlin O'Brien

Newborn Medicine, Boston Children's Hospital

Peter Weinstock

Anesthesia and Critical Care Medicine, Boston Children's Hospital

Elizabeth Doherty

Newborn Medicine, Boston Children's Hospital

For correspondence:
elizabeth.doherty@childrens.harvard.edu

Christine Rachwal

Newborn Medicine, Boston Children's Hospital

Kristen Lindamood

Newborn Medicine, Boston Children's Hospital

Caitlin O'Brien

Newborn Medicine, Boston Children's Hospital

Peter Weinstock

Anesthesia and Critical Care Medicine, Boston Children's Hospital