Mental Prep for Trauma Care May Mitigate ER Errors

APRIL 21, 2015
Rachel Lutz
By mentally rehearsing resuscitation procedures, trauma care team members can reduce clinical errors and improve patient safety.

Researchers from St. Michael’s Hospital in Toronto and Rockyview General Hospital in Calgary recently evaluated the effectiveness of mental practice in coordinating interdisciplinary trauma team efforts.

“We know that the most consequential mistakes in medicine are not technical or procedural, but nontechnical in nature—errors in communication, leadership, role clarity, resource utilization,” noted lead study author Christopher M. Hicks, MD, MEd, in a press release.

In the study, 78 residents were grouped into 2-member teams, 20 of which engaged in 20 minutes of quiet mental mapping of key Advanced Trauma Life Support (ATLS) principles and protocols that promote teamwork, while 19 teams in the control group received 20 minutes of face-to-face training on the ATLS algorithm and nontechnical elements of team-based trauma care.

 The mental practice teams had a median number of 2 years of postgraduate years of training, while the control group teams had 3.

Both groups then participated in simulated adult trauma resuscitation situations and received debriefing afterward about communication, leadership, and teamwork. Blinded raters scored the video recordings of the simulations using the Mayo High Performance Teamwork Scale, a validated team-based behavioral rating scale.

The mental practice group significantly outperformed the control group, especially on teamwork behaviors like communication. Of a total potential score of 24, the mental practice group scored a median of 21.5, while the control group scored a median of 19.

“Mental practice appears to help establish common team goals, set priorities, and maintain situation awareness in advance so teams can be prepared for even the most complex and challenging trauma resuscitation,” Dr. Hicks explained. “We’re borrowing principles from performance athletes, musicians and even the military, to help guide clinicians during high-stress, challenging situations.”
The researchers believe this is the first study to demonstrate mental mapping’s positive effects on trauma teams’ performance.

“[Mental practice] performed as a team may support developing effective shared mental models for team-based and task-based processes,” the authors concluded. “…We feel that [mental practice] may be a useful and inexpensive tool for improving nontechnical skills instruction effectiveness for team-based trauma care.”

The study was published in the April 2015 edition of the Canadian Journal of Emergency Medicine.

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