Integrating Interprofessional Team Training in the Pediatric Life Support Program

Background/Rationale: Empirical evidence supports health care delivered by well-functioning teams leads to better outcomes. Effective teamwork behaviors between healthcare team members have been linked to improved outcomes including mortality rates, cardiac arrests, nosocomial infections, and complications. Organizations including the Institute of Medicine, the Joint Commission, and the Agency of Healthcare Research and Quality have advocated for team training to improve communication and support an organizational culture supportive of patient safety. The methods and related expenses of team training initiatives vary considerably, with programs lasting from several hours to days. This disparity has raised concern from those who seek to implement the IOM recommendations in a manner that will achieve the most return on investment.

In a unique and cost effective approach, Thomas et al conducted a randomized, controlled study incorporating team training into an existing Neonatal Resuscitation Program (NRP). More frequent teamwork behaviors and shortened duration of simulated resuscitations were demonstrated after two-hour team training was added to the standard NRP curriculum. The proposed study is to extend the work of Thomas et al in the pediatric environment.

Study Purpose/Aim: The specific aim is to evaluate the effectiveness of a two-hour team training program incorporated into an established Pediatric Advanced Life Support (PALS) curriculum relative to resuscitation performance and the presence of specific teamwork behaviors compared to control groups using the standard PALS curriculum alone.

Methods: A randomized, controlled trial will be conducted. Participants will be randomly assigned to either intervention or control groups. The independent variable will be a standardized two hour teamwork curriculum that will include didactic presentations and simulation. Teamwork observers, blinded to intervention status and tested for inter-rater reliability, will view Megacode resuscitation videos and score PALS performance based on established criteria. A sample size of 120 participants (60 intervention and 60 control) will permit finding a moderate effect size of 0.80 (S.D. units) on a continuous variable at 80% power, and a one tailed alpha level of 0.05.

Expected Outcomes/Implications:

The primary outcome will be the resuscitation performance score in the two groups, which will be examined using a difference in means. Based on descriptive analysis of associated variables, a linear regression model may be fitted to look at the multivariate nature of the contribution of factors such as communication style, years in position, etc. Additional outcomes include the presence of specific teamwork behaviors.

The results of this study will be used to determine whether team training should be incorporated in current PALS, BLS and NRP courses on a regular basis. If the two-hour training demonstrates a positive impact on PALS performance and/or teamwork behaviors and/or it could become a standard component of all interprofessional resuscitation curricula.