By Wendy Sarubbi | August 21, 2023 9:21 am

Paramedics rush the 5-year-old boy to your hospital because he’s not breathing. His doctor was treating him for pneumonia, but now he is lifeless on a gurney with no pulse. What do you do?

Dr. Shiva Kalidindi, an Emergency Medicine physician at Nemours Children’s Health, leads the simulation.

That was the scene of a recent College of Medicine simulation exercise, designed to show second-year medical students the dos and don’ts of crisis care, communication and teamwork.

The simulation taught concepts of TeamSTEPPS, the Agency for Healthcare Research and Quality’s evidence-based process for better teamwork and communication to improve patient safety. The event was planned and developed by Dr. Shiva Kalidindi, an Emergency Medicine physician at Nemours Children’s Health in Lake Nona in collaboration with Jason Konzelmann, the medical school’s new Director of the Clinical Skills and Simulation Center.

Konzelmann is a certified master TeamSTEPPS trainer and a paramedic with more than 25 years of service. He comes to UCF with career experience from the New York Simulation for Health Sciences, a partnership between New York University School of Medicine and the City University of New York, and DeSales University, where he developed simulation training for the school’s healthcare students. He plans to expand simulations as part of the College of Medicine curriculum.  The reason: Simulations are active learning and allow students the opportunity to apply what they learn in lectures. “Simulation allows the students to be more engaged,” Konzelmann said, “to experience and practice real-world clinical situations in a safe learning environment.”

Jason Konzelman is the new director of UCF’s Clinical Skills and Simulation Center.

In this simulation, Dr. Kalidindi played the role of the team leader in the care of the critically ill child. With two medical student volunteers, Konzelmann and Nemours resident Dr. Victoria Vazquez, the medical team did two simulations – one without using TeamSTEPPS  and the other incorporating its processes.

The first simulation was chaotic. Providers weren’t sure who was doing what.  Communication was frantic. Did the med student doing CPR know how many compressions to do? Who was checking for a pulse? Dr. Kalidindi ordered Epinephrine to help restart the heart. Who was administering the drug? Was it the right dose? The team was nervous and unsure. “Where’s the EPI?” Dr. Kalidindi yelled at one point. “Hurry up!”

The second simulation, centered on TeamSTEPPS concepts, provided a stark contrast for a variety of reasons:

  • BRIEFING – When the patient arrived in the ER, Dr. Kalidindi did a short but powerful team briefing. He announced he would be the team lead and that the team’s goal was to get the patient breathing and send to the ICU for further treatment. He assigned everyone a task – using their name so assignments were clear. The briefing helped assure everyone was sharing the same mindset.
  • SBAR – This acronym is a technique for communicating simply, quickly and effectively during an emergency. S is for SITUATION – What’s happening with the patient? In this case, he’s not breathing. B is for BACKGROUND – what is the background on this patient? In this case, the patient is 5 years old and was being treated clinically for pneumonia. His parents called 911 because he stopped breathing. ASSESSMENT – What do we think is the problem? RECOMMENDATION AND REQUEST – What do we need to do to correct this patient’s problem?
  • CALL-OUT AND CHECK-BACK COMMUNICATION. This system ensures that everyone on the team is staying informed with accurate, real-time data. Providers don’t just all share at a monitor to see what’s happening. The team lead calls out for information, such as “Do we have a pulse?” The person in charge of that process reports back. “No pulse.” Check-back communication means that when the team lead asks that a specific task be done, the person responsible repeats the directive and then confirms the action is completed. The team lead also asks throughout the situation for suggestions on what else can be done to help the patient.
  • CUS – This acronym is used when someone on the team believes a directive or action may be wrong – and puts the patient at risk. In the first simulation, when Dr. Kalidindi directed Konzelmann to give a specific does of Epinephrine, Konzelmann  said he wasn’t sure the dose was correct. But there wasn’t clear communication about the concern, which added to the chaos and the issue was never resolved. In the second simulation, Konzelmann used CUS. He expressed that he had a CONCERN and said why. He said the dose made him UNCOMFORTABLE and why – he thought it was too high for the patient’ size. Then he expressed that he believed the ordered dose would jeopardize the patient’s SAFETY. He didn’t accuse, he wasn’t emotional – he was specific, factual and respectful. He asked the doctor if he could use a written pharmacy guide to check the dosage based on the patient’s actual size. The team lead agreed and the guide showed the dose was too high. Dr. Kalidindi responded by saying he “stood corrected” and ordered the new dose so the circle of communication was complete.

The UCF students had studied TeamSTEPPS during their first year of medical school. But the simulation exercise was the first time they’d seen it in practice – and watched the impact of when their teachers and classmates failed to use the tools. After discussing how and when TeamSTEPPS concepts could have been applied, the group reran the same scenario, modeling how the communication and team skills could be applied in any scenario to enhance patient care.

Dr. Vazquez, a second-year resident at Nemours, told students how using TeamSTEPPS in the real world helps her feel more confident as she learns to respond to emergencies. After the session, she said she hoped the simulation would help the UCF students’ build patient safety “muscle memory.”

Dr. Kalidindi emphasized that the teamwork and communication system is all about the patient. “None of you are more important that the patient you are caring for,” he said. “We cannot compromise the safety of the patient because of ego issues.”

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