Article Text
PDF
Abstract
Background Examine how Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) can be used to manage patient safety and improve the standard of care for patients.
Methods In order to improve key medical training in areas like surgical safety management, blood transfusion closed-loop management, drug safety management and identity recognition, we apply the TeamSTEPPS teaching methodology. We then examine the effects of this implementation on changes in pertinent indicators.
Results Our hospital’s perioperative death rate dropped to 0.019%, unscheduled reoperations dropped to 0.11%, and defined daily doses fell to 24.85. Antibiotic usage among hospitalised patients declined to 40.59%, while the percentage of antibacterial medicine prescriptions for outpatient patients decreased to 13.26%. Identity recognition requirements were implemented at a rate of 94.5%, and the low-risk group’s death rate dropped to 0.01%. Critical transfusion episodes were less common, with an incidence of 0.01%. The physician’s TeamSTEPPS Teamwork Perceptions Questionnaire and Teamwork Attitudes Questionnaire scores dramatically improved following the TeamSTEPPS team instruction course.
Conclusion An evidence-based team collaboration training programme called TeamSTEPPS combines clinical practice with team collaboration skills to enhance team performance in the healthcare industry and raise standards for medical quality, safety, and effectiveness.
- Teamwork
- Leadership
- Patient safety
Data availability statement
Data sharing not applicable as no datasets generated and/or analysed for this study.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
WHAT IS ALREADY KNOWN ON THIS TOPIC
Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is a national standard for medical team training.
Medical quality and safety management is important for a hospital’s growth and long-term survival.
The value of medical team cooperation has been highlighted more and more in China.
WHAT THIS STUDY ADDS
By using the TeamSTEPPS training mode, we have improved medical safety management, particularly with regard to identity recognition, blood and pharmaceutical safety, and surgical safety.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
The integration of clinical practice and team collaboration abilities through TeamSTEPPS can improve team performance in the healthcare sector and elevate the bar for medical quality, safety and efficacy.
Introduction
The foundation of hospital growth and survival is medical quality and safety, which also serve as a safeguard for patient interests and positive doctor–patient interactions.1 Medical quality and safety management is important for a hospital’s growth and long-term survival.2 A constant theme in hospital management is the protection of medical quality and safety, which also safeguards patient interests and the preservation of doctor–patient relationships.3 4 With numerous medical procedures and a broad variety of regions involved, managing the entire process of medical quality and safety is somewhat hard. It is challenging to control the overall quality and safety of medical care.5 The medical quality and safety of patients seeking medical care suffer from a lack of quality control over a number of linkages, and the management of medical quality and safety as a whole also suffers from this problem.6 New standards for managing medical quality and safety have been proposed in recent years as a result of the health administrative authorities’ ongoing deployment of various management policies and strategies.7 According to Guo Ban Fa [2017] No. 67, the General Office of the State Council’s guiding opinions on the establishment of a modern hospital management system, hospitals should set up a medical quality management and control system that encompasses the entire process of clinical diagnosis and treatment services.8 They should also strengthen the quality and safety management of important departments, areas, links and technologies.
A recognised training programme called Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is thought to improve team collaboration.9 TeamSTEPPS, a national standard for medical team training, was announced by the Department of Defense and the US Healthcare Research and Quality Agency in November 2006. Leadership, situational monitoring, mutual support and effective communication are the four fundamental team collaboration abilities that TeamSTEPPS identifies as trainable. According to research, integrating multidisciplinary team collaboration into clinical practice can raise the calibre of healthcare and guarantee patient safety.10 With a focus on surgical safety, blood and pharmaceutical safety, and identity identification among the top 10 patient safety goals, this study evaluated the effectiveness of TeamSTEPPS in patient safety education and multidisciplinary team collaboration.
Methods
Management of hospital medical quality and safety using the TeamSTEPPS model
Our hospital employs a two-level system of hospital department responsibility and is governed by hospital leaders. We fully support and promote the hospital’s activities on quality improvement and patient safety through a committee management framework. With 12 subcommittees, the Quality Improvement and Patient Safety Management Committee has a strong management structure (figure 1).
The Management Committee for Patient Safety and Hospital Quality Improvement.
For safety management, the TeamSTEPPS model is introduced using the medical key links as a starting point.11 Strictly implementing the verification system, increasing drug safety and enhancing medical personnel’s identity recognition accuracy are the top 10 aims for patient safety. Our nation recently released a notice of comprehensive action to improve medical quality, which included a call to strengthen medication management and guarantee surgical quality and safety. Since 2020, the TeamSTEPPS model has been implemented for safety management, drawing on the prevalent areas of weakness in the medical treatment provided by our hospital in the past. A course discussion group made up of core members from the medical, nursing and hospital infection prevention and control departments is formed, along with a TeamSTEPPS management team headed by the medical vice president. Training plans are designed based on the medical key links, and training is conducted through case sharing, slides teaching and scenario simulation exercises.12 Pay attention to the following four factors: (1) Strengthening leadership. (2) Creation of a team environment. Create a welcoming environment for team communication by developing a collaborative and supportive team approach. (3) Develop situational awareness and a thorough understanding of one another’s circumstances. (4) Develop communication abilities. Each month, a weekend will be set out for the training, which will last an hour.
Improve the management of surgical safety
The three parties of anaesthesia, surgery and nursing are tightly related during the surgical process.13 The surgical process needs close cooperation from multiple teams and disciplines.14 The Time out programme is used by our hospital to create a culture of safety in the operation room.15 We emphasise three steps of verification: before anaesthesia induction, before surgical skin cutting and before patients leave the operating room.16 In order to ensure the accuracy and correctness of the surgical patient, surgical site, surgical procedure and other information, surgical team members pause their activities prior to the start of these three procedures and have the surgeon, anaesthesiologist and surgical nurse jointly verify the patient’s basic information. This is a safety check during surgery.17 Using case sharing, scenario simulation exercises and other techniques, TeamSTEPPS training helps the operating room team members understand their roles through collaboration and communication, as well as enhancing their communication abilities (figure 2).
The safety checklist for operation center and Intensive Care Unit.
Strengthen blood transfusion closed-loop management
The process of donating blood is complicated, risky and frequently leads to serious mistakes. Based on TeamSTEPPS, enhance teamwork throughout the blood transfusion process, create efficient communication model and enhance blood transfusion process processing, particularly during the execution phase, where emphasis is placed on completing the double check on the personal digital assistant and noting the executor at each stage. In order to achieve intelligent prompts and prevent errors, intelligent review and control were adopted in tandem with the identification of danger spots throughout the entire blood transfusion process. This allowed for the automatic and intelligent review of patient blood transfusion kinds (figure 3).18
For homotypic and heterotypic blood transfusion processes, the blood transfusion system will block the procedure when an error occurs. PDA, personal digital assistant.
Bolster drug administration
A knowledge base for children’s prescription and medical guidance appropriate for China’s national conditions has been built in response to the lack of a database on children’s rational drug usage in China. Information on conventional dosage, maximum dosage, route of administration, frequency of administration, repeated drug use, drug interactions, solvent compatibility of injections, injection concentration and duration of administration, allergies (to drugs and foods), pharmacogenomics and other topics are covered in the content. It is a component of the hospital’s cognitive decision-making system for responsible and safe medication usage. It can perform the following two tasks: first, it can automatically recommend usage and dosage, which means that when a doctor enters an order, the system will suggest typical usage and dosage to assist with entering the proper dosage; second, it can perform the preapproval method, which involves sending an entire medical order or prescription to the rational medication software for review before sending it to a human reviewer. Medical orders are split into three safety categories, red (level 7), yellow (level 6) and green (level 1–5), depending on how serious the potential repercussions are. These orders are intercepted, manually evaluated and approved (table 1).
Drug review evaluation
The knowledge about safe drug use is refined into six modules using a modular technique based on TeamSTEPPS; these modules are taught using multimedia by pharmacists and expert doctors, respectively; offer a variety of training programmes, like case sharing, to lower the number of drug errors.
Improving identity recognition
Implement TeamSTEPPS training into the clinical workflow in a progressive, hierarchical and modular manner. The Medical Quality Management Committee, for instance, places a lot of emphasis on identity recognition oversight. Our hospital uses two pieces of information to verify patient identity: the patient’s name and the hospitalisation number (also known as an outpatient number). In contrast to the past, which entirely relied on manual identification, PDAs are now used to scan and validate wristbands and medication labels.19 The PDA is also programmed to carry out the medical order process, which directs the nursing check process. Establish diverse identity verification methods and enhance the uniformity of identity identification through TeamSTEPPS training and simulation of various circumstances.
Results
Medical quality and safety management’s efficiency
The hospital has significantly increased the level of medical quality management and managed crucial links through TeamSTEPPS training. In 2022, our hospital’s perioperative death rate dropped to 0.019%, unscheduled reoperations dropped to 0.11%, and defined daily doses fell to 24.85. Antibiotic usage among hospitalised patients declined to 40.59%, while the percentage of antibacterial medicine prescriptions for outpatient patients decreased to 13.26%. Identity recognition requirements were implemented at a rate of 94.5%, and the low-risk group’s death rate dropped to 0.01%. Critical transfusion episodes were less common, with an incidence of 0.01% (table 2).
Medical quality control indicators
T-TAQ and T-TPQ scales’ paired analysis results before and after the course
The TeamSTEPPS supporting questionnaires are TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) and TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ). T-TAQ comprises a total of 5 dimensions and 30 items, encompassing team composition, management, situational awareness, interpersonal cooperation and communication. The scale uses a Likert 5-level rating system, and medical professionals self-evaluate their attitude towards teamwork connected to patient treatment and safety. Each dimension has six items. The more points, the better the medical staff members’ attitude towards working as a team. T-TPQ and T-TAQ both have 35 elements and a total of 5 dimensions. The scale uses a Likert 5-level rating system, and the medical staff’s self-evaluation of teamwork inside their organisation is better. Each dimension has seven items. Medical professionals completed 40 T-TAQ and T-TPQ scales, respectively, before and after the course. Prior to and during the TeamSTEPPS team teaching course, resident physicians’ T-TPQ and T-TAQ scores varied statistically significantly (p<0.05) (table 3).
T-TAQ and T-TPQ scale comparisons before and after the course
Discussion
Our hospital had little training on teamwork prior to putting the TeamSTEPPS training model into practice, and doctors with various backgrounds were prone to poor communication, which might result in medical mistakes or even accidents. There were major dangers, particularly with regard to identity recognition, blood and medicine safety, and surgical safety. We have implemented the TeamSTEPPS training approach, which is based on the real circumstances of our hospital and emphasises sharing work skills and fostering collaboration and communication among physicians, nurses, pharmacists and medical technicians.
The value of medical team cooperation has been highlighted more and more in China; however, traditional medical models lack team cooperation education and training.20 The TeamSTEPPS training model,21 22 which is tailored to China’s national requirements, can be used to combine the country’s current medical resources and environment with the goal of making up for various weaknesses in medical team cooperation while also enhancing patient safety and medical quality. The use of team training in patient safety produces a very high level of medical acceptance, in contrast to traditional educational approaches.23 The environment is immersive, and there are many options for interaction and communication for medical staff. The study’s findings indicate that after using the team training mode, medical and nursing cooperation attitudes scored higher than they did previously across four dimensions: teamwork, safety climate, management perspective and job satisfaction. Data before and after the course show that TeamSTEPPS can significantly increase patient safety in critical medical procedures including surgery, blood transfusion and medicine24. It is worth promoting since it is highly practical, covers a wide range of topics and allows hospital staff from all levels to take part in the training.
Breaking down the inherent cognitive barriers between medical fields, broadening team members’ cognitive horizons and productive teamwork are the aims of TeamSTEPPS training.25 In order to build a safety awareness of communication and mutual support within multidisciplinary teams, it is required to increase the integration of many disciplines, including clinical medicine, nursing and pharmacy, in TeamSTEPPS education.26 To create a TeamSTEPPS teaching system that is in line with the objectives of multidisciplinary talent cultivation, clarify the components of the TeamSTEPPS teaching system, assess the issues with multidisciplinary team cooperation in clinical practice and connect TeamSTEPPS theory and practice.
Today, one of the biggest problems facing health systems all around the world is patient safety. In the USA, the National Patient Safety Agency’s mission statement calls for avoiding, minimising and limiting harm brought on by adverse events during the course of medical treatment.27 Our hospital’s perioperative mortality rate, unplanned reoperation rate and low-risk group mortality rate have all dropped since TeamSTEPPS teaching was applied to critical patient safety aspects. This has significantly improved the level of medical quality management.
Developing a safety culture is necessary to meet patient safety objectives.28 In the future, we should work to find new ways to enhance the patient safety culture in hospitals, broaden the population and application reach of TeamSTEPPS and apply the software more to medical staff communication and adverse event analysis.
Data availability statement
Data sharing not applicable as no datasets generated and/or analysed for this study.
Ethics statements
Patient consent for publication
Ethics approval
Not applicable.
Acknowledgments
We express our deep gratitude to the patients and their families for their willingness and cooperation in the study.
References
Footnotes
YS and SM contributed equally.
Contributors Conceptualisation: YS and XZ. Data curation: SM, YF and CS. Methodology: YS, SM, YF and CS. Project administration: YS and HW. Supervision: XZ. Visualisation: YS. Writing—original draft: YS. Writing—review and editing: YS, SM, YF, CS, HW and XZ. Guarantor: XZ.
Funding This study was supported by Evaluation Study on Fudan Pediatric Medical Consortium’s Response to Public Health Emergencies Based on the Prevention and Control of COVID-19 of Shanghai Municipal Health Commission under Grant No 202150028; Practical Research on Medical Management of Integrated Paediatric COVID-19 Designated Hospital in peacetime and wartime of Shanghai Shenkang Hospital Development Center under Grant No 2022SKMR-17; Optimization of Hospital Emergency Management System Based on Response to Sudden Infectious Diseases, FDYGC2023010, Fudan University Shanghai Medical College Hospital Management Office.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.