以醫療異常事件發展高擬真團隊訓練模擬課程

Using Adverse Events to Develop a High-Fidelity, Simulation-Based Team Training Program

目的：近年醫療機構開始提倡團隊合作的重要性，而團隊模擬訓練在國內仍屬起步階段。本研究目的在結合異常事件通報案例，發展一套高擬真團隊模擬訓練課程。
方法：教案以異常事件通報案例改編。發展「團隊模擬訓練觀測量表」為評量工具，共23 題，分團隊及總和評估二部份，具良好信效度。運用高擬真模擬人環境進行演練，課程2-3 小時，包括環境介紹、情境演練及回饋。
結果：自2011 年6 月至2012 年2 月共25 梯次訓練，5 例標準化教案，104 名學員完訓。觀察發現，在團隊及總和評估呈現一致的結果，於團隊組成與領導向度中，加護團隊表現顯著低於急診團隊（p ＜ 0.05）；在溝通技巧的向度中，加護團隊與手術團隊表現皆顯著低於急診團隊（p ＜ 0.05）。98% 學員對本課程呈現高度滿意。
結論：基於無傷害學習原則，學員可藉由本訓練體驗團隊合作，避免異常事件重。本成果值得持續推廣，使臨床人員將知識與技能化為日常行動，發揮團隊合作效，提升病人安全。

Objective: Teamwork is important in the healthcare industry; however, simulation of clinical team practice is still in its infancy in Taiwan. The objective of this study was to integrate medical adverse events into a high-fidelity, simulation-based team training program.Methods: The training scenarios were adopted based on medical adverse events which had occurred in the research hospital. A validated, 23-item "Simulation TeamTraining Survey" was developed to assess individual and integrated team performance. The training used a high-fidelity simulator in a simulated clinical setting. A typical training session lasted for 2-3 hours and included orientation, scenario practice, and feedback.Results: A total of 5 standardized scenarios were use to train 104 trainees participated between June 2011 and February 2012. Findings were consistent across individual and integrated team performances. The Intensive Care Unit teamdid not perform as well as the Emergency Room team (p < 0.05) in the dimensions of team formation and leadership. The Intensive Care Unit and Operating Room teams did not perform as well as the Emergency Room team in the dimension of communication (p < 0.05). Ninety eight percent of the trainees were highly satisfied with the high-fidelity, simulation based team training.Conclusions: Trainees can practice team skills in a no- harmsetting. High-fidelity, simulation-based team training may help clinicians integrate their team knowledge and skills into daily practice with the ultimate goal of improving patient safety.