The Association Between Technical and Non-technical Skills in Real-life ALS Situations. Impact of Pit Crew Model on the Resuscitation Skills.

June 4, 2021 updated by: Turku University Hospital

Cardiac arrest is handled by cardiopulmonary resuscitation which is a time critical emergency situation. The actions during resuscitation are lead by international guidelines. Traditionally, the main focus of the training has been on medical knowledge and technical skills (TS). Nowadays non-technical skills (NTS), such as communication, teamwork behaviour, and leadership, are considered at least equally important.

The aim of this study is to evaluate both TS and NTS of the resuscitation team during real-life resuscitation situations using a validated assessment tool. The association between TS and NTS will be analyzed. Findings from this study may help to recognize the possible weaknesses and issues which could be improved by training. Hypothesis is that that TS are probably in a high level, but some improvement points of NTS are ought to be known better. Investigators hypothesis that the good NTS performance in resuscitation is accompanied by good TS performance.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Background

Cardiac arrest is a time-critical emergency situation, which is treated by cardiopulmonary resuscitation (CPR). The actions during resuscitation are lead by international guidelines (Nolan et al 2010). Because of the relatively rare nature of cardiac arrests in many wards and clinics, regular resuscitation training is necessary.

During cardiopulmonary resuscitation and other sudden medical crisis situations, in addition to medical knowledge and technical skills (TS), also non-technical skills (NTS) are needed (Castelao et al 2011, Fletcher et al 2002, Helmreich et al 1999, Gaba et al 1998). NTS are behavioural elements which are ought to improve team performance. The importance of NTS has been demonstrated only in a simulated settings, not in a real life.

Drawbacks in team organization and communication are frequent problems within advanced life support (ALS) events (Risaliti et al, Colquitt et al). As unclear team member roles can cause errors during ALS (Weng et al, Ornato et al) more emphasis should be placed on educating specific roles and responsibilities to resuscitation team members (Soar et al, Maney et al). Pit crew models for resuscitation, where all resuscitation team members have their pre-assigned positions and pre-arranged roles and tasks to perform ALS have been developed to respond these problems. (Gonzales et al, Pearson et al, Glendenning et al, Ong et al, Hopkins et al, Spitzer et al)

Objective, purpose, and hypothesis

The first part of this study (ID T70/2012) aims to evaluate the technical and especially non-technical skills of the resuscitation team during real-life resuscitation situations. Investigators hypothesis that good non-technical performance is related on good technical performance. Findings from this study may help to recognize the possible weaknesses and issues which could be improved by training. The hypothesis is that technical skills are probably on a high level, but some improvement points of non-technical skills are ought to be known better.

The second part of the study aims to evaluate the impact of a pit crew model on ALS skills. (ID: T70/2012)

Design and Methods

Turku University Central Hospital lies in a Southwestern part of Finland, and provides medical services for 865 000 inhabitants. The target group of this study is the resuscitation team of the adult ICU of Turku University Central Hospital. This team consists of an ICU doctor (most commonly an anaesthesiologist specialized for intensive care), two ICU nurses, and one medical technician. These people are treating approximately 90 cardiac arrests per year, but this group also gets other alarms (like shortness of breath, unconscious patients and other acute situations). This ICU resuscitation team takes care of all resuscitation calls in the newer part of the Turku University Hospital, when the older parts of the hospital are taken care either by a resuscitation team from pediatric ICU or by prehospital emergency medical service system.

The data from 20 video-recorded real-life resuscitation situations treated by resuscitation team in Turku University Hospital will be collected and the overall NTS and TS score will be measured using a validated assessment tool (Peltonen et al 2017). The association between the TS and NTS will be analyzed by statistical methods. In addition, after each recorded resuscitation situation, every member of the resuscitation team will be called by a phone. During the calls team members are asked to tell examples, what went well during the resuscitation, and what could have been done better. Based on these answers, inductive analysis will be made.

A pit crew model for resuscitation will be implemented in our organizations' resuscitation team responding cardiac arrest alarms. We will continue to video-recording after the intervention, and similarly, NTS and TS will be measured using the validated assessment tool (Peltonen et al 2017). In the second part of the study, we will compare the pre- and post-intervention ALS-performance in the videos.

Ethics

The study protocol was approved by the Ethics Committee of Turku University. All ALS-situations in Turku University newer hospital building area are considered eligible to the study regardless of the initial rhythm or presumed aetiology. Written information consent of patients is not needed, because the study is directed at resuscitation team performance, not the patients. The patients are not identified at any phase of the study.

Study Type

Observational

Enrollment (Actual)

37

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

The target group of this study is the resuscitation team of the adult ICU of Turku University Central Hospital. This team consists of an ICU doctor (most commonly an anaesthesiologist specialized for intensive care), two ICU nurses and one medical technician.

Description

Inclusion Criteria:

  1. a doctor, a nurse, a paramedic or a medical technician working on adult ICU resuscitation team
  2. all the members of the ICU resuscitation team in the CPR-situation are volunteer to take part in the study

Exclusion Criteria:

1) if any member of the ICU resuscitation team in the CPR-situation refuse to be video recoded

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Resuscitation team
Resuscitation pit crew model is educated to the resuscitation team.
Other: Pit crew model education
A pit crew model for resuscitation is educated to all resuscitation team members.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
To measure the association of the NTS and TS on one-another using validated assessment tool.
Time Frame: one year
one year

Secondary Outcome Measures

Outcome Measure
Time Frame
To evaluate the association between NTS and TS subgategories.
Time Frame: one year
one year

Other Outcome Measures

Outcome Measure
Time Frame
To evaluate the impact of the pit crew model.
Time Frame: two years
two years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Turku University Hospital

Investigators

  • Principal Investigator: Miretta Tommila, MD, Turku University Hospital
  • Study Director: Sanna Salanterä, PhD, RN, Vice Head of the Department of Nursing Science and Nurse Director at Turku University Hospital, Finland
  • Study Chair: Ville Peltonen, Lic.Med, Turku University Hospital
  • Study Chair: Laura-Maria Peltonen, M.Sc. RN, University of Turku, Finland, Nursing Science
  • Study Chair: Teemu Elomaa, Lic.Med, Turku University Hospital
  • Study Chair: Jaana Elomaa, RN, Turku University Hospital
  • Study Chair: Tomi Pappila, RN, Vakka-Suomi Hospital Tyks, Finland
  • Study Chair: Sanna Hoppu, MD, Tampere University Hospital, Finland
  • Study Chair: Eeva Hevonoja, RN, University of Turku, Finland
  • Study Chair: Saija Hurme, University of Turku, Finland
  • Study Chair: Katariina Perkonoja, University of Turku, Finland

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

June 1, 2012

Primary Completion (Actual)

December 1, 2018

Study Completion (Actual)

September 1, 2020

Study Registration Dates

First Submitted

October 17, 2016

First Submitted That Met QC Criteria

January 9, 2017

First Posted (Estimate)

January 11, 2017

Study Record Updates

Last Update Posted (Actual)

June 9, 2021

Last Update Submitted That Met QC Criteria

June 4, 2021

Last Verified

June 1, 2021

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • T70/2012

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Patients treated by cardiopulmonary resuscitation (CPR) in the videos can be recognized. Video material can not be shared due to patient privacy. Other data is possible to share.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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