Improving Self-Efficacy and Teamwork in Moderate Acuity Clinical Situations

Background: Practice tools and training are essential to building staff confidence, competency, teamwork, perceived self-efficacy, and by extension, they improve clinical outcomes. For new providers in many hospital settings, there is an emphasis on training in Advanced Cardiac Life Support (ACLS) and code blue situations compared to lower acuity, higher frequency moderate acuity situations. For the purpose of this scholarly project, moderate acuity (MAC) situations are defined as situations at the project site that require a higher level of care and often multiple members of the intradisciplinary team. By applying some of the key principles of Advanced Cardiac Life Support delivery (role identification, closed-loop communication, simulation training, and situation debriefing) to the more frequent MAC situations, new providers will have an established care delivery framework to increase the quality of patient care and avoid errors in care delivery. Methods: A quality improvement project was developed to improve self-efficacy and teamwork. A 6-week retrospective chart review identified and obtained specific data on the most common moderate acuity situations at the project site and a guideline was developed. Staff then participated in simulation training on role identification, closed-loop communication, debriefing, task assistance, mutual support, and feedback. Following the training, a 6-week implementation period consisted of bi-weekly emphasis on different techniques outlined in the training as well as surveys to collect information on real-life MAC situations. Pre- and post-education/ implementation surveys were done to evaluate the feasibility, usability and satisfaction, and effectiveness of the education on teamwork and self-efficacy Results: No reported medication errors, adverse patient events, or miscommunications within the department during the implementation phase of the project were identified. The Team Emergency Assessment Measure pre-implementation assessment had a mean score of 45.3 (N=18) and a post-implementation assessment mean score of 47.1 (N=14). The General Self Efficacy score had a pre-implementation assessment mean score of 33.88 (N=18) and a post- implementation assessment mean score of 34.9 (N=15). Debriefs were performed using the new guideline 75% of the time after a MAC situation at the project site (N=7). Conclusions: The MAC situation guideline appears to be a valuable resource to help increase providers' perceived self-efficacy and teamwork. Replication of this quality improvement project is needed to determine if similar results would occur at other project sites. This increase in confidence levels and training could ultimately improve patient outcomes overall.