Presentation
Virtual Reality Interprofessional Simulation Education to Improve Teamwork and the Culture of Safety in the Emergency Department
DescriptionInterprofessional team simulations have a significant impact on clinical practice and learning, which in turn improves teamwork, communication, and interprofessional collaboration (Sezgin et al., 2023). They provide opportunities to learn collaborative practices and improve communication across teams (Chen et al., 2022) and can improve the safety and teamwork climate in the clinical setting, ultimately reducing patient safety events (Schmidt et al., 2021; Joseph et al., 2022). There is preliminary data that indicates immersive team-based virtual reality (VR) simulations can be equally as effective as live interprofessional simulations in improving teamwork and communication (Qiao et al., 2021).
The purpose of this project is multifold, including assessing the impact of interprofessional virtual reality (VR) simulation-based education for ad hoc emergency teams of nurses and physicians on teamwork, safety culture, and VR technology acceptance in the Yale New Haven Hospital Emergency Department (ED). We will use previously validated tools to measure the impact of VR simulation-based interprofessional education on 1. changes in attitudes in teamwork and communication, 2. changes in safety climate in the emergency department, and 3. perceptions of VR technology acceptance by emergency clinicians. A secondary aim of this project is to promote nurse feelings of being a part of the interprofessional care team; this is operationally defined as a decreased attrition rate among emergency department nurses at Yale New Haven Hospital.
Emergency nurses and physicians, including resident trainees and attendings, participated in VR interprofessional clinical scenarios utilizing SimX's Virtual Reality Medical Simulation System (VRMSS) with Meta 3 Quest headsets. The VRMSS provides pre-programmed scenarios that auto-advance based on participant actions that are monitored by a remote moderator. As part of the pre-brief the session, each participant is fitted with a Meta 3 Quest headset, ensuring that the straps are appropriately tightened to offload weight, as well as adjusting the pupillary distance to accommodate those who have visual difficulties. The facilitators guide the team through a review of the controls and discuss the possibility of simulator sickness, advising all participants they may remove their headset at any time and exit the scenario. To minimize simulator sickness, participants remain in the headsets for 15-20 minute blocks of time, removing them for discussion.
Each clinical scenario includes a maximum of 5 participants, including 2-3 nurses and 1-2 providers. The participants will complete a total of two VR clinical scenarios as a team, working on assessing and treating their virtual patient. Afterwards, the participants remove their headsets for the scenario debriefs, which cover teamwork, communication, as well as clinical aspects of the case. Each session is 2.5 hours including the following agenda:
- Consent/Pre-survey - 15 minutes
- Pre-brief - 15 minutes
- VR orientation & practice - 15 minutes
- SimX Scenario 1 - 15 minutes
- Scenario 1 debrief - 30 minutes
- SimX Scenario 2 - 15 minutes
- Scenario 2 debrief & overall takeaways - 30 minutes
- Post-survey - 15 minutes
The measures for the project include pre, post, and one month surveys capturing teamwork, communication, culture of safety, and technology acceptance. Participant demographic information collected includes age, gender, race, years of clinical experience, and years of experience working in the emergency department. The AHRQ TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) has been used in previous studies to understand the impact of interventions on teamwork attitudes and will be used as a pre, post, and follow up measure of teamwork and communication (Baker et al., 2010; Keebler et al., 2014). This tool measures team dynamic attitudes across five domains including team structure, leadership, mutual support, situation monitoring, and communication.
The Yale New Haven Health System’s annual culture of safety survey section on ‘Resource & Teamwork’ will be used to better understand the potential impact on the safety culture in the ED. An adapted virtual reality technology acceptance model tool (VR-TAM) will be used to understand the utilization of SimX's VRMSS for emergency clinicians (Wang et al., 2023). To measure the impact on the ED nurse attrition, we will use departmental data that tracks the number of emergency nurses who transferred out of or left the ED over the 6 months prior to and 6 months after the intervention.
This project focuses on developing and fostering a culture of safety within a hospital unit and will also discuss how to foster ideal patient safety practices using VR technology. This is a strong example of how technology can effectively support messaging across hospital systems. It can also be used to support onboarding new employees or employees who have recently changed roles. It seeks to provide safety as a proactive rather than a reactive activity and reinforces learning through simulation. More importantly, it focuses on communication and patient safety as individuals must complete tasks and work with others to complete clinical activities.
References:
Baker DP, Amodeo AM, Krokos KJ, et al. Assessing teamwork attitudes in healthcare: development of the TeamSTEPPS teamwork attitudes questionnaire. Qual Saf Health Care 2010;19:e49.
Chen, H. W., O'Donnell, J. M., Chiu, Y. J., & et al. (2022). Comparison of learning outcomes of interprofessional education simulation with traditional single-profession education simulation: A mixed-methods study. BMC Medical Education, 22(1), 651. https://doi.org/10.1186/s12909-022-03640-z
Joseph, M. M., Mahajan, P., Snow, S. K., Ku, B. C., & Saidinejad, M. (2022). Optimizing pediatric patient safety in the emergency care setting. Pediatrics, 150(5), e2022059674. https://doi.org/10.1542/peds.2022-059674
Keebler, J. R., Dietz, A. S., Lazzara, E. H., & et al. (2014). Validation of a teamwork perceptions measure to increase patient safety. BMJ Quality & Safety, 23, 718–726.
Qiao, J., Xu, J., Li, L., & Ouyang, Y. Q. (2021). The integration of immersive virtual reality simulation in interprofessional education: A scoping review. Nurse Education Today, 98, 104773. https://doi.org/10.1016/j.nedt.2021.104773
Schmidt, J., Gambashidze, N., Manser, T., & et al. (2021). Does interprofessional team-training affect nurses' and physicians' perceptions of safety culture and communication practices? Results of a pre-post survey study. BMC Health Services Research, 21(1), 341. https://doi.org/10.1186/s12913-021-06137-5
Sezgin, M. G., & Bektas, H. (2023). Effectiveness of interprofessional simulation-based education programs to improve teamwork and communication for students in the healthcare profession: A systematic review and meta-analysis of randomized controlled trials. Nurse Education Today, 120, 105619. https://doi.org/10.1016/j.nedt.2022.105619
Wang, E. Y., Kennedy, K. M., Zhang, L., Qian, D., Forbes, T., Zuniga-Hernandez, M., Li, B. S.-K., Domingue, B., & Caruso, T. J. (2023). Predicting pediatric healthcare provider use of virtual reality using a technology acceptance model. JAMIA Open, 6(3), ooad076. https://doi.org/10.1093/jamiaopen/ooad076
The purpose of this project is multifold, including assessing the impact of interprofessional virtual reality (VR) simulation-based education for ad hoc emergency teams of nurses and physicians on teamwork, safety culture, and VR technology acceptance in the Yale New Haven Hospital Emergency Department (ED). We will use previously validated tools to measure the impact of VR simulation-based interprofessional education on 1. changes in attitudes in teamwork and communication, 2. changes in safety climate in the emergency department, and 3. perceptions of VR technology acceptance by emergency clinicians. A secondary aim of this project is to promote nurse feelings of being a part of the interprofessional care team; this is operationally defined as a decreased attrition rate among emergency department nurses at Yale New Haven Hospital.
Emergency nurses and physicians, including resident trainees and attendings, participated in VR interprofessional clinical scenarios utilizing SimX's Virtual Reality Medical Simulation System (VRMSS) with Meta 3 Quest headsets. The VRMSS provides pre-programmed scenarios that auto-advance based on participant actions that are monitored by a remote moderator. As part of the pre-brief the session, each participant is fitted with a Meta 3 Quest headset, ensuring that the straps are appropriately tightened to offload weight, as well as adjusting the pupillary distance to accommodate those who have visual difficulties. The facilitators guide the team through a review of the controls and discuss the possibility of simulator sickness, advising all participants they may remove their headset at any time and exit the scenario. To minimize simulator sickness, participants remain in the headsets for 15-20 minute blocks of time, removing them for discussion.
Each clinical scenario includes a maximum of 5 participants, including 2-3 nurses and 1-2 providers. The participants will complete a total of two VR clinical scenarios as a team, working on assessing and treating their virtual patient. Afterwards, the participants remove their headsets for the scenario debriefs, which cover teamwork, communication, as well as clinical aspects of the case. Each session is 2.5 hours including the following agenda:
- Consent/Pre-survey - 15 minutes
- Pre-brief - 15 minutes
- VR orientation & practice - 15 minutes
- SimX Scenario 1 - 15 minutes
- Scenario 1 debrief - 30 minutes
- SimX Scenario 2 - 15 minutes
- Scenario 2 debrief & overall takeaways - 30 minutes
- Post-survey - 15 minutes
The measures for the project include pre, post, and one month surveys capturing teamwork, communication, culture of safety, and technology acceptance. Participant demographic information collected includes age, gender, race, years of clinical experience, and years of experience working in the emergency department. The AHRQ TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) has been used in previous studies to understand the impact of interventions on teamwork attitudes and will be used as a pre, post, and follow up measure of teamwork and communication (Baker et al., 2010; Keebler et al., 2014). This tool measures team dynamic attitudes across five domains including team structure, leadership, mutual support, situation monitoring, and communication.
The Yale New Haven Health System’s annual culture of safety survey section on ‘Resource & Teamwork’ will be used to better understand the potential impact on the safety culture in the ED. An adapted virtual reality technology acceptance model tool (VR-TAM) will be used to understand the utilization of SimX's VRMSS for emergency clinicians (Wang et al., 2023). To measure the impact on the ED nurse attrition, we will use departmental data that tracks the number of emergency nurses who transferred out of or left the ED over the 6 months prior to and 6 months after the intervention.
This project focuses on developing and fostering a culture of safety within a hospital unit and will also discuss how to foster ideal patient safety practices using VR technology. This is a strong example of how technology can effectively support messaging across hospital systems. It can also be used to support onboarding new employees or employees who have recently changed roles. It seeks to provide safety as a proactive rather than a reactive activity and reinforces learning through simulation. More importantly, it focuses on communication and patient safety as individuals must complete tasks and work with others to complete clinical activities.
References:
Baker DP, Amodeo AM, Krokos KJ, et al. Assessing teamwork attitudes in healthcare: development of the TeamSTEPPS teamwork attitudes questionnaire. Qual Saf Health Care 2010;19:e49.
Chen, H. W., O'Donnell, J. M., Chiu, Y. J., & et al. (2022). Comparison of learning outcomes of interprofessional education simulation with traditional single-profession education simulation: A mixed-methods study. BMC Medical Education, 22(1), 651. https://doi.org/10.1186/s12909-022-03640-z
Joseph, M. M., Mahajan, P., Snow, S. K., Ku, B. C., & Saidinejad, M. (2022). Optimizing pediatric patient safety in the emergency care setting. Pediatrics, 150(5), e2022059674. https://doi.org/10.1542/peds.2022-059674
Keebler, J. R., Dietz, A. S., Lazzara, E. H., & et al. (2014). Validation of a teamwork perceptions measure to increase patient safety. BMJ Quality & Safety, 23, 718–726.
Qiao, J., Xu, J., Li, L., & Ouyang, Y. Q. (2021). The integration of immersive virtual reality simulation in interprofessional education: A scoping review. Nurse Education Today, 98, 104773. https://doi.org/10.1016/j.nedt.2021.104773
Schmidt, J., Gambashidze, N., Manser, T., & et al. (2021). Does interprofessional team-training affect nurses' and physicians' perceptions of safety culture and communication practices? Results of a pre-post survey study. BMC Health Services Research, 21(1), 341. https://doi.org/10.1186/s12913-021-06137-5
Sezgin, M. G., & Bektas, H. (2023). Effectiveness of interprofessional simulation-based education programs to improve teamwork and communication for students in the healthcare profession: A systematic review and meta-analysis of randomized controlled trials. Nurse Education Today, 120, 105619. https://doi.org/10.1016/j.nedt.2022.105619
Wang, E. Y., Kennedy, K. M., Zhang, L., Qian, D., Forbes, T., Zuniga-Hernandez, M., Li, B. S.-K., Domingue, B., & Caruso, T. J. (2023). Predicting pediatric healthcare provider use of virtual reality using a technology acceptance model. JAMIA Open, 6(3), ooad076. https://doi.org/10.1093/jamiaopen/ooad076
Authors
Event Type
Oral Presentations
TimeTuesday, April 111:30am - 12:00pm EDT
LocationPier 9
Simulation and Education (SE)