| Description |
Dr. Vincent T. Covello, the director of the Center for Risk Communication states that, "Stress and mental noise can reduce the ability to process information by up to 80%" (p. 34). The high stress nature and criticality of a patient requiring air medical transport cannot be understated. The transport of a mechanical circulatory support (MCS) patient is exponentially complex and stressful. In these transports, clear interprofessional communication can be the difference between life and death. The purpose of this project is to improve interprofessional communication and collaboration. By improving teamwork and communication at the bedside, the team will improve patient safety and improve critical decision making during these extremely critical transports. MCS patients consist of those utilizing Intraaortic Balloon Pumps (IABP), Ventricular Assist Devices (VAD), Impella, and Extracorporeal Membrane Oxygenation (ECMO). The primary indication for IABP, VAD's and Impella's is acute heart failure resistant to vasopressor treatment. The primary indication for VenoArterial (VA) ECMO is acute and severe heart failure that is resistant to other interventions. The primary indication for VenoVenous (VV) ECMO is Profound Acute Respiratory Distress Syndrome (ARDS), Pneumonia or other forms of lung failure that is resistant to other interventions (ELSO, 2017). The overriding priority in transporting the patient to the ECMO center is patient safety (ELSO, 2015). The sometimes chaotic and unpredictable nature of treating critical patients in the field makes communication even more important, but often more difficult (Bronsky & Woodson, 2018). Safe transport of MCS patients requires a highly technical interdisciplinary team that must utilize open, clear and calm communication to maintain patient safety. There have been many studies since To Err Is Human (Kohn & Donaldson, 2000), that show that poor communication contributes to a significant number of sentinel events both in the hospital and the pre-hospital environment. The Joint Commission cited a study that showed communication failure contributed to 30% of malpractice claims and over 1,744 deaths over a 5-year period (Joint Commission, 2017).Healthcare professional students are educated in profession-centered silos limiting opportunities to develop effective communication and collaboration practices (Titzer, Swenty & Wilson, 2015). As healthcare professionals are not commonly educated or trained together, they are also not learning or practicing good communication skills between disciplines. Interprofessional education and training is key in improving communication and collaboration between healthcare professionals, specifically for the transport team. In air medical transport, team communication is called Crew Resource Management (CRM) and originated with the aviation industry. According to Sweeney et. al. (2014), Medical simulation is recognized as a best practice for teaching crew resource management and interprofessional communication. Most seasoned professionals can struggle to communicate well in a stressful environment in which they are the only provider. A mechanical circulatory support transport team consists of an MCS device specialist nurse, a transport nurse, paramedic and respiratory therapist. When the level of stress is combined with an increased number of professionals from diverse backgrounds, high quality interprofessional communication becomes a cornerstone to delivering proper care. A poor interaction or miscommunication could lead to mismanagement of the patient or the MCS devices the patient is dependent upon. Utilizing simulation for training allows the team to recreate life-threatening and high stress situations without ever having to put a patient in danger. |
