title: Educational program in crisis management for cardiac surgery teams including high realism simulation.
abstract: BACKGROUND
  Cardiac surgery demands effective teamwork for safe, high-quality care. The objective of this pilot study was to develop a comprehensive program to sharpen performance of experienced cardiac surgical teams in acute crisis management.
  
  
  METHODS
  We developed and implemented an educational program for cardiac surgery based on high realism acute crisis simulation scenarios and interactive whole-unit workshop. The impact of these interventions was assessed with postintervention questionnaires, preintervention and 6-month postintervention surveys, and structured interviews.
  
  
  RESULTS
  The realism of the acute crisis simulation scenarios gradually improved; most participants rated both the simulation and whole-unit workshop as very good or excellent. Repeat simulation training was recommended every 6 to 12 months by 82% of the participants. Participants of the interactive workshop identified 2 areas of highest priority: encouraging speaking up about critical information and interprofessional information sharing. They also stressed the importance of briefings, early communication of surgical plan, knowing members of the team, and continued simulation for practice. The pre/post survey response rates were 70% (55/79) and 66% (52/79), respectively. The concept of working as a team improved between surveys (P = .028), with a trend for improvement in gaining common understanding of the plan before a procedure (P = .075) and appropriate resolution of disagreements (P = .092). Interviewees reported that the training had a positive effect on their personal behaviors and patient care, including speaking up more readily and communicating more clearly.
  
  
  CONCLUSIONS
  Comprehensive team training using simulation and a whole-unit interactive workshop can be successfully deployed for experienced cardiac surgery teams with demonstrable benefits in participant's perception of team performance.
authors.affiliation: Division of Cardiac Surgery, Centre Hospitalier Universitaire de Montréal, Montreal, Quebec, Canada. lm.stevens@videotron.ca
authors.forename: Louis-Mathieu
authors.initials: LM
authors.lastname: Stevens
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Cooper
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Raemer
authors.forename: Robert C
authors.initials: RC
authors.lastname: Schneider
authors.forename: Allan S
authors.initials: AS
authors.lastname: Frankel
authors.forename: William R
authors.initials: WR
authors.lastname: Berry
authors.forename: Arvind K
authors.initials: AK
authors.lastname: Agnihotri
mesh_terms: D006348:Cardiac Surgical Procedures / Q000193:education*; D002983:Clinical Competence; D003198:Computer Simulation; D003422:Critical Care / Q000592:standards*; D003479:Curriculum; D003657:Decision Making; D004502:Education, Medical, Continuing / Q000379:methods*; D006126:Group Processes; D006801:Humans; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D007857:Leadership; D009873:Operating Rooms; D010348:Patient Care Team / Q000458:organization & administration*; D016544:Patient Simulation; D010865:Pilot Projects; D011787:Quality of Health Care; D011795:Surveys and Questionnaires