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Beeinflusst jährliches Simulationstraining das Sicherheitsklima einer universitären Klinik?

Prospektive Fünfjahresuntersuchung anhand Dimensionen des „Safety Attitudes Questionnaire“

Does annual simulation training influence the safety climate of a university hospital?

Prospective 5‑year investigation using dimensions of the safety attitude questionnaire

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Zusammenfassung

Hintergrund

Ein regelmäßiges Crew-Resource-Management (CRM)-basiertes Simulationstraining verändert möglicherweise die Sicherheitskultur einer Organisation. Im Jahr 2012 wurde an der Anästhesiologischen Klinik ein jährliches Simulationstraining etabliert. Anhand von Dimensionen des Safety Attitudes Questionnaire (SAQ) sollte die Frage beantwortet werden, ob sich bei wiederholter Teilnahme an einem Simulationstraining sicherheitsrelevante Einstellungen von Teilnehmenden verändern.

Methode

Es wurden 3 Dimensionen des SAQ (Teamarbeitsklima, Sicherheitsklima, Stresswahrnehmung) sowie eigene Frageitems zu Vorbesprechungen (Briefings) und zum „speaking up“ verwendet. Vor Beginn jedes Simulatorkurses wurden die Teilnehmenden gebeten, den Fragebogen auszufüllen. Anhand eines personalisierten Codes konnten bei wiederholter Teilnahme Daten anonym Individuen zugeordnet werden. Zur Auswertung wurde die Fünfpunkte-Likert-Skala in eine 100-Punkte-Skala transformiert. Die mittlere Veränderung pro Jahr wurde mit einem univariablen linearen Regressionsmodell berechnet.

Ergebnisse

Die Antworten von 255 Personen wurden erfasst. Jedes Jahr nahmen ≤20 % der pflegerischen und ≤90 % der möglichen ärztlichen Belegschaft teil. Der jährliche Anteil an neuen Mitarbeitern betrug 16–24 %. Anhand eines personalisierten Codes konnte ein Vorher-nachher-Vergleich mit 99 Personen erfolgen, die 2‑mal und häufiger teilgenommen hatten. Vor Beginn des ersten Trainings schätzten Ärzte die Teamarbeit besser ein als Pflegekräfte (+8,7; p < 0,001). Die Einschätzung vor Beginn des ersten Simulationstrainings stieg im Beobachtungszeitraum leicht an: Sie betrug pro Jahr 3,11 für das Teamarbeitsklima (p < 0,001) und 2,73 für das Sicherheitsklima (p = 0,001). Bei mehrfacher Teilnahme war die Veränderung bei Pflegekräften etwas stärker ausgeprägt (Teamarbeitsklima 5,2 (Pflege) vs. 1,4 (Ärzte); Sicherheitsklima 5,3 (Pflege) vs. 2,8 (Ärzte)) ohne Signifikanz zu erreichen.

Schlussfolgerung

Ein jährliches CRM-basiertes Simulationstraining kann beim Teamarbeitsklima und Sicherheitsklima eine geringe Veränderung über die Zeit bewirken. Eine geringe Teilnahme an Pflegekräften und eine hohe Personalfluktuation schwächen möglicherweise die Auswirkungen des Trainings auf das Sicherheitsklima ab.

Abstract

Background

Simulation-based training with a focus on non-technical skills can have a positive influence on safety relevant attitudes of participants. If an organization succeeds in training sufficient staff, it may experience a positive change in the safety climate. As the effects of a single training are of a transient nature, annual training sessions may lead to an incremental improvement of safety relevant attitudes of employees over time. In spring 2012 the Department of Anesthesia at the University Hospital of Erlangen established an annual simulation-based training for staff members (e.g. consultants, trainee anesthetists and nurse anesthetists).

Objective

The study aimed to test whether an annual simulation-based training would result in an incremental longitudinal improvement in attitudes towards teamwork, safety and stress recognition.

Methods

A survey comprising three domains (teamwork climate, safety climate and stress recognition) of the safety attitudes questionnaire (SAQ) and items addressing briefing and speaking up was distributed to all participants in an annual in-house simulation training. Participants filled out the questionnaire in the morning of each training day. The attitudes were measured before the first training series in 2012, 6 months after the first training and then every year (2013–2016). Participants generated a personalized identification code which allowed individuals to be anonymously tracked over time. Results of the 5‑point Likert scale were transformed to a 100-point scale. Results were calculated at the group level and at the individual level. Univariable linear regression was used to calculate mean changes per year.

Results

Over a period of 5 years (2012–2016) a total of 255 individuals completed the questionnaire. Each year, 14–20% of all nurse anesthetists and 81–90% of all anesthetists participated in the simulation-based training. As a result of annual staff turnover 16–24% of participants were new staff members. A personalized code allowed the before and after comparison of 99 staff members who had participated twice or more. Physicians had a higher mean score for teamwork climate before the first training (+8.7 p < 0.001). Mean teamwork climate and safety climate scores before the first training increased over a period of 5 years (3.11 for teamwork climate, p < 0.001 and 2.73 for safety climate, p < 0.001). Repeat participation led to a bigger mean change of individual attitudes in nurse anesthetists: teamwork climate 5.2 (nurses) vs. 1.4 (physicians) and safety climate 5.3 (nurses) vs. 2.8 (physicians) without reaching significance. Participants acknowledged the importance of briefings but confirmed their existence in less than half of the cases. The frequency of briefings increased over the 5‑year period. There were no changes in attitude towards speaking up.

Conclusion

Over a 5-year period, small positive changes in attitudes towards teamwork and safety occurred. Low participation of nurse anesthetists as well as personnel turnover may have weakened the impact of simulation-based training on the safety climate.

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Danksagung

Wir danken Frau Prof. Dr. Tanja Manser, Institut für Patientensicherheit am Universitätsklinikum Bonn, und Herrn Prof. Dr. David Schwappach, Stiftung Patientensicherheit Schweiz, für die kritische Durchsicht des Manuskripts. Wir danken allen Kolleginnen und Kollegen des Simulationsteams für ihr jahrelanges und anhaltendes Engagement, ohne das unser gemeinsames Projekt nicht realisierbar wäre.

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Authors and Affiliations

  1. Anästhesiologische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland

    M. St.Pierre Dr., G. Breuer & J. Schüttler

  2. Lehrstuhl für Medizininformatik, Biometrie & Epidemiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland

    C. Gall

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Correspondence to M. St.Pierre Dr..

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M. St. Pierre, C. Gall, G. Breuer und J. Schüttler geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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St.Pierre, M., Gall, C., Breuer, G. et al. Beeinflusst jährliches Simulationstraining das Sicherheitsklima einer universitären Klinik?. Anaesthesist 66, 910–923 (2017). https://doi.org/10.1007/s00101-017-0371-8

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