急重症高擬真模擬情境團隊訓練成效初報

The Preliminary Report of Effectiveness of High Fidelity Simulation Based Team Training in Critical Care

目的：探討高擬真模擬訓練方式能否提升醫護人員對於病人安全的認知，並能提高團隊合作，運用於臨床常規工作。方法：接受過課堂式團隊資源管理課程訓練的急診與加護病房學員，再次接受2 個半小時的高擬真模擬訓練，訓練前後發放課程問卷與「病人安全文化量表(Safety Attitudes Questionnaire, SAQ)」，評量此項訓練是否能提升學員對於團隊合作技巧內容了解程度與臨床實務應用程度，以及受訓單位同仁病人安全文化認知程度。結果：學員在完成高擬真模擬訓練後，對於團隊合作知識與技巧記憶程度提高、臨床運用的困難度也消失。在病人安全文化認知方面，無論是急診或是加護病房人員，在「團隊合作」（急診50%、加護病房57.4%）與「單位安全風氣」（急診41.7%、加護病房42.6%）正向回答百分比皆高於同儕醫院。結論：在接受傳統課堂式訓練之後，進行高擬真模擬訓練除了讓學員更加熟悉團隊資源管理知識與技巧，更能提升參與訓練單位的病人安全文化認知，但未來需進一步分析證實此訓練活動對於臨床照護品質正面提升的影響。

Objectives: We investigated the effectiveness of the high-fidelity simulation training on the improvement of team work and patient safety attitudes. Methods: With the prerequisite of attending class-based Team Resource Management (TRM) course, students from emergency department (ED) and intensive care unit (ICU) undertook the two-and-half hour simulationbased team training. Course evaluation form and Safety Attitudes Questionnaire (SAQ) were distributed before and after the training to determine whether the simulation-based training can enhance trainees' team knowledge and skills, whether they can practice on routine clinical works, and how the patient safety attitudes have changed following the simulation-based TRM training. Outcomes: After simulation-based training, trainees well refreshed their team knowledge and skills learned from previous TRM training. Trainees showed more confidence in executing team skills in daily clinical works. In terms of patient safety attitudes, both ED and ICU scored higher positive responses on "teamwork climate"(ED is 50% and ICU is 57.4%) and"safety climate"(ED is 41.7% and ICU is 42.6%) subscales, as compared to peer data. Conclusion: Apart from the initial traditional class-based training, high-fidelity, simulation-based training can refresh trainees' team knowledge and skills. Their patient safety attitudes showed significant improvement following training. However, more studies need to be done in the future to further confirm the effectiveness of the simulation-based team training on the clinical care quality.