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Advanced closed-loop communication training: the blindfolded resuscitation
  1. Kate E Hughes1,
  2. Patrick G Hughes2,
  3. Thomas Cahir3,
  4. Jennifer Plitt1,
  5. Vivienne Ng1,
  6. Edward Bedrick4,
  7. Rami A Ahmed5
  1. 1Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona, USA
  2. 2Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida, USA
  3. 3Arizona Health Sciences Center, University of Arizona, Tucson, Arizona, USA
  4. 4Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
  5. 5Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
  1. Correspondence to Dr Kate E Hughes, Emergency Medicine, University of Arizona, Tucson, AZ 85724, USA; hughesk{at}aemrc.arizona.edu

Abstract

Closed-loop communication (CLC) improves task efficiency and decreases medical errors; however, limited literature on strategies to improve real-time use exist. The primary objective was whether blindfolding a resuscitation leader was effective to improve crisis resource management (CRM) skills, as measured by increased frequency of CLC. Secondary objectives included whether blindfolding affected overall CRM performance or perceived task load. Participants included emergency medicine (EM) or EM/paediatric dual resident physicians. Participants completed presurveys, were block randomised into intervention (blindfolded) or control groups, lead both adult and paediatric resuscitations and completed postsurveys before debriefing. Video recordings of the simulations were reviewed by simulation fellowship-trained EM physicians and rated using the Ottawa CRM Global Rating Scale (GRS). Frequency of CLC was assessed by one rater via video review. Summary statistics were performed. Intraclass correlation coefficient was calculated. Data were analysed using R program for analysis of variance and regression analysis. There were no significant differences between intervention and control groups in any Ottawa CRM GRS category. Postgraduate year (PGY) significantly impacts all Ottawa GRS categories. Frequency of CLC use significantly increased in the blindfolded group (31.7, 95% CI 29.34 to 34.1) vs the non-blindfolded group (24.6, 95% CI 21.5 to 27.7). Participant’s self-rated perceived NASA Task Load Index scores demonstrated no difference between intervention and control groups via a Wilcoxon rank sum test. Blindfolding the resuscitation leader significantly increases frequency of CLC. The blindfold code training exercise is an advanced technique that may increase the use of CLC.

  • simulation
  • communication skills
  • emergency medicine
  • assessment of crisis management skills
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Footnotes

  • Twitter @RamiAhmedDO

  • Contributors KEH provided substantial contributions to concept and design, acquisition of data, analysis and interpretation of data and drafting of manuscript. PGH provided substantial contributions to concept and design, acquisition of data, analysis and interpretation of data, drafting of manuscript and critical manuscript revision.TC provided substantial contributions to concept and design, acquisition of data, analysis and interpretation of data, drafting of manuscript and statistical expertise. JP provided substantial contributions to acquisition of data, analysis and interpretation of data and drafting of manuscript. VN provided substantial contributions to concept and design, drafting of manuscript and critical manuscript revision. EB provided substantial contributions to concept and design, analysis of data and statistical expertise. RAA provided substantial contributions to concept and design, analysis and interpretation of data and critical revision of manuscript for important intellectual content. KEH agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval University of Arizona IRB (IRB #1802261498).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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