Investigating the Redesign Implementation Strategy of Simulated Multidisciplinary Trauma Team Training (TTT) on Health Service and Patient Outcomes: An Embedded Experimental Mixed-methods Study

Abstract

Introduction: In an emergency, trauma teams must form quickly and function effectively. Simulation is used to teach teamwork skills. It is not known about how training is used in clinical practice. Aim: (1) to evaluate the effects of a simulated multidisciplinary TTT program on patient outcomes and team members’ experiences of teamwork in real-world trauma resuscitations, and (2) to inform the future design of TTT programs and translate learnings to clinical practice. Methods: An embedded experimental mixed-method study was used. First, a retrospective review of 2,389 trauma patients was conducted, with 1,116 patients in the four years preceding TTT, and 1,273 patients in the subsequent four years. Second, 86 trauma team members who attended training completed a questionnaire to identify factors affecting teamwork in clinical practice. Third, interviews were used to explore team members’ experiences and perspectives of the effect of TTT on team performance. Results: Patient outcomes data showed a reduction in the time to critical operations in major trauma patients following TTT. The survey identified 16 facilitators and 12 barriers to teamwork in real-life resuscitations. The interviews illustrated that training should focus on developing teamwork skills specific to ‘flash teams’—that is, trauma teams with unstable membership, that form quickly. Integration of the quantitative and qualitative results demonstrated why training helped ‘flash teams’ in time-critical situations, and identified the content to be included in TTT programs. Conclusion: Educational efficiency and contextualised local implementation strategies were key to improving the training’s influence on multidisciplinary team performance in resuscitation events. Teaching teamwork within the context of a dynamically changing team is recommended.