Trauma Resuscitation using in-situ Simulation Team training: Bringing Life to Trauma M&M Rounds
CCCF ePoster library. White K. 11/02/16; 150987; 106 Disclosure(s)(s): Royal College, SimOne grants
Kari White
Kari White
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Topic: Quality Assurance & Improvement

Trauma Resuscitation using in-situ Simulation Team training: Bringing Life to Trauma M&M Rounds

Petrosoniak, Andrew1; White, Kari2; McGowan, Melissa1; Rizoli, Sandro3; Ahmed, Najma3; Campbell, Doug2; Hicks, Christopher1
1Emergency Department, St. Michael's Hospital, Toronto, Canada; 2Medical Education/Simulation Centre, St. Michael's Hospital, Toronto, Canada; 3General Surgery, St. Michael's Hospital, Toronto, Canada

Grant acknowledgements:
Royal College Medical Education Research GrantSim-One/CPSI Grant


Morbidity and mortality (M&M) rounds are traditionally conducted retrospectively, didactically, led by the non-treating physician, and often with little to no interprofessional (IP) representation. With the increased emphasis on a culture of patient safety across the health care spectrum, traditional approaches to M&M rounds have been under review by individual institutions.  Changing the approach to M&M rounds from retrospective to prospective, and utilizing in-situ simulation (ISS) as the technique to review cases, fosters an IP environment of opportunity for input on change and timely identification of gaps, practice barriers, logistical challenges, and latent safety hazards (LSTs).
We sought to move the trauma M&M round format from a retrospective, uniprofessional, physician led to a prospective, interprofessional, multidisciplinary, physician/non-physician co-led ISS based approach.
At a single, Level 1 trauma centre, all unexpected deaths or adverse events were reviewed with input from institutional stakeholders and senior leadership. Themes from this review were used to inform the development of four high-fidelity, ISS scenarios using either a mankin or standardized patient.  Monthly, unannounced, ISS sessions were conducted in the trauma bay, with activation of the actual IP trauma team.  All sessions were A/V recorded and followed by a semi-structured debriefing session.   Both a physician and simulation educator facilitated the debriefing sessions. The clinical and non-clinical members of the trauma team were engaged in discussions about member identification of LSTs, barriers to care, and team function.
We conducted 12 monthly, unannounced, IP, high-fidelity ISS sessions to prospectively review trauma cases providing opportunity for all team members to reflect and provide feedback on self-identified barriers to safe and effective care, including LSTs, ergonomically arduous equipment issues, process or logistical challenges, and team function (communication, leadership, role clarity and resource allocation). IP team member’s learning opportunities were highlighted in the debriefing sessions.  Engagement of clinical and non-clinical members in the simulation scenarios and the debriefing sessions led to successful implementation of this alternative approach to trauma M&M rounds.  The redesign of the massive transfusion protocol, specific to activation in trauma, was a resulting change with the execution of this new strategy to trauma M&M rounds.  The investigation into issues with the current protocol was initiated by voiced concerns from a non-clinical team member – a Clinical Assistant, brought forward in multiple debriefing sessions. 
This is an innovative approach to the delivery of trauma M&M rounds using ISS as the technique for education and opportunity for change.  Multidisciplinary, IP engagement in discussions around medical error and adverse events in the delivery of care to a trauma patient, leading to education and change, is key to the success of a trauma M&M rounding strategy.   In using ISS to recreate scenarios from a trauma registry where unexpected deaths or adverse events occurred, we were able to shift the culture of learning into the clinical space.  Both clinical and non-clinical trauma team members provided input on barriers to providing care, highlighted learning moments, and offered suggestions on improvement strategies. 


Calder LA, Kwok ESH, Cwinn AA, et al. Enhancing the Quality of Morbidity and Mortality Rounds: The Ottawa M&M Model. Academic Emergency Medicine 2014;21:314-21.
Higginson J, Walters R, Fulop N. Mortality and morbidity meetings: an untapped resource for improving the governance of patient safety? BMJ Qual Saf 2012; 21:576-85.

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