Trial of Emergency Medicine Protocols In Simulation Training
The Trial of Emergency Medicine Protocols In Simulation Training (TEMPIST) is a randomised block-controlled trial of Emergency Protocols in simulated time-critical emergencies.
TEMPIST seeks to demonstrate an improvement in the management of time-critical emergencies using the handbook of Emergency Protocols, compared with standard care.
Measuring the effectiveness of the cognitive aid requires precise outcome measures and controlled scenarios, both of which are impractical in real-life emergencies. There is good support for high-fidelity simulation in the medical literature, with outcomes correlating with real-life performance. High-fidelity simulation allows detailed observation, including video-recording, that would be impossible in these infrequent real-life emergencies.
TEMPIST is a randomised block-controlled study comparing team performance, in terms of adherence to current resuscitation guidelines, with and without the handbook. Secondary objectives are:
- to determine whether variable within the teams have an effect on overall performance
- to determine participant’s subjective experience of using the handbook.
The TEMPIST investigators are:
- A/Prof Charlotte Hall (Rural Sub Dean, Western Sydney University and Emergency Physician, Lismore Base Hospital)
- Dr Dean Robertson (GP VMO, Emergency Department, Maclean District Hospital)
- A/Prof Megan Passey (Deputy Director of Research, University Centre for Rural Health, Lismore and Director, Australian Rural Health Research Collaboration, University of Sydney)
- Dr Sabrina Pitt (Workforce Research Stream Leader, University Centre for Rural Health, Lismore and School of Public Health, University of Sydney)
- Dr Margaret Rolfe (Biostatistician and Research Fellow, University Centre for Rural Health, Lismore and School of Public Health, University of Sydney)
- Ms Sharene Pascoe (Clinical Simulation Manager, University Centre for Rural Health, Lismore and Clinical Nurse Consultant, Lismore Base Hospital)
Participants will be recruited from medical and nursing staff who have worked in an Australian emergency department in the past 12 months. They will manage four simulated emergency medicine scenarios. Groups will be randomly assigned to manage each scenario with or without the handbook. High-fidelity manikins will be used.
Use of the TEMPIST cognitive aid will be easily scalable across NSW. Time-critical emergencies are managed using the same guidelines across NSW, but local variation contributes to adverse patient outcomes. The use of the cognitive aid should help reduce local variation, applying the existing guidelines in a standardised manner across NSW. Standardisation would also benefit doctors and nurses moving between facilities, providing a recognised and familiar cognitive aid, thereby improving patient care.
The study is powered to yield definitive results, and should not need replication. If the cognitive aid proves effective, as anticipated, then roll-out requires only the distribution of handbooks to emergency departments and training in their use. The ECI is a core partner in this project and will facilitate state-wide implementation.
It is anticipated that the TEMPIST study will demonstrate that the management of time critical medical emergencies is improved by using a specifically designed cognitive aid. Currently no such evidence exists in Australia or internationally. This would likely herald a new standard of practice.
The Agency for Clinical Innovation has awarded the TEMPIST investigators a grant to complete the trial and support roll-out across NSW hospitals.
If the TEMPIST trial finds that the cognitive aid is effective in simulation training, then the management of time-critical emergencies is likely to change dramatically. Applying the positive finding requires an inexpensive handbook and basic training in its use. There is no change in the approved guidelines, only that the guidelines are more accurately applied. The evidence generated by the trial is likely to be widely adopted by clinicians managing medical emergencies, particularly if participants subjectively value the cognitive aid, as expected (and measured by the questionnaire). The combination of good evidence and clinician engagement is potent.
Adoption of a cognitive aid improves teamwork in emergency scenarios, and is likely to increase interest in the “human factors” aspect of medical emergencies. Such a paradigm shift is likely to further improve patient management.