engleski

Challenges instructors meet while teaching on European Trauma Course (ETC)

Background: Every 5 years, the ERC presents Guidelines changes, based on evidence and coupled to implementation strategies. A new Dutch EMS standard (LPA8) incorporates fundamental changes to cervical spine (collar) management during resuscitation of trauma patients. The strategy changed from “always (cervical collar) immobilization, except...” to “no collar immobilization, except...” with as goal decreased intra-cranial pressure. We observed that presentation of semi-reclining patients in a vacuum mattress, or with just head blocks, seemed related to an overall major increase in content- and procedure-oriented protocol deviations, not seen after CPR guideline changes. Note, for example, that semi-reclining cannot be continued on a CT-gantry. Materials andmethods:We systematically observed the effects on workflow and training. We approached trained team participants, asked their opinion/motivation on the change, deviations and remediation with, as a goal, a new consensus, workflow and content. Results: Major key medical and training points were: - Change in cervical spine management was seen as a preemptive, poorly communicated, fundamental deviation from key training and treatment points, based on limited evidence. Intrinsic perception of causing sub-standard care caused low acceptance: acceptance factor. - Change management caused loss of overall focus in the resuscitative surveys: focus factor. - Change required un-learning ingrained workflow: workflow skills factor. We found that non-acceptance (most frequently seen as “yes, but ...”) early in workflow is strongly related to a negative domino effect throughout the whole team effort leading to errors, increased run-through time and missed finding during the surveys. Retraining needed to focus on acceptance, un-training and then re- training. Particularly, the historical strategy persisted strongly. Notably, we found that not changing care and workflow, despite paucity of supporting evidence, seems to be better accepted than introducing changes with equally strong or ambivalent evidence. Level of seniority could not be indicated as a consistent factor. Conclusion: Change management requires acceptance by all chain partners. Changes perceived as fundamental require specific attention (un-learning, motivation in the face of selective evidence, re-commitment). Introduction of even small distractions to workflow may cause disproportionate errors and deviations from care standards.

trauma course, challenges, spine immobilisation, workflow, skill

nije evidentirano