Parallel-group randomized study on the impact of a modified TeamSTEPPS training on resident and nurse attitudes toward teamwork and their adherence to patient safety protocols

Introduction: Gaps remain in what constitutes optimal healthcare team training in terms of design and impact. This study utilizes a parallel group randomized design to study the impact of a modified TeamSTEPPS training on resident and nurse attitudes toward teamwork and their adherence to patient safety (PS) protocols. Methods: The intervention randomized 76 participants (38 nurses and 38 1st year residents) equally into one of four parallel training groups to receive central venous catheter (CVC) lines simulation training with and without a modified 1-h TeamSTEPPS training. Both groups participated in video-based CVC instruction and a simulation CVC case scenario using high-fidelity mannequins. Participants were randomized twice: Initially into TeamSTEPPS and non-TeamSTEPPS training groups using a computer-generated randomization list, and then into resident-nurse pairs prior to the simulation CVC case scenario by selecting room assignments out of a hat. At the conclusion of a training session, participants completed the TeamSTEPPS questionnaire to measure perceptions for teamwork. Resident/nurse pairs' adherence to PS protocols during the simulation CVC case were recorded by the laboratory's audio/video system to measure team performance. Three trained and blinded postdoctoral research associates scored all recordings independently. Residents were eligible for the study if they were a 1st year postgraduate trainees with no prior TeamSTEPPS training. Nurses were eligible if they had <5 years of Intensive Care Unit experience and no prior TeamSTEPPS training. The principal investigator recruited volunteers through the hospital's E-mail system. Consent was obtained prior to training via E-mail and again at the start of each session. The setting was an independent teaching hospital in an urban setting that trains approximately 400 house staff. Results: Repeated-measures analyses of variance showed significant differences in attitudes of teamwork between groups. However, there was no significant difference in adherence to safety markers between groups. There was high, >70% exact agreement among the three raters. Exploratory analyses revealed that team behaviors predicted adherence to PS protocols. No adverse events or side effects were observed or reported. Conclusions: This study found that a modified TeamSTEPPS training improved resident and nurse attitudes of teamwork. However, this improvement did not translate into differences between groups with and without the TeamSTEPPS training in their adherence to PS protocols. Additional research is needed to determine the optimal team-training designs that improve PS. This research was funded by a research grant from the Albert Einstein Society, Philadelphia, PA, and was approved for exemption by Einstein Medical Center Philadelphia campus's Institutional Review Board. The authors report no declarations of interest. The following core competencies are addressed in this article: Medical knowledge, interpersonal and communication skills, patient care, practice-based learning and improvement, professionalism, and systems-based practice.