This document summarizes a proposed research study that will investigate the impact of a team leader's physical presence versus telepresence on teamwork and communication during simulated pediatric emergency cases. The study will be a randomized controlled trial that recruits resident physician teams to complete a simulated pediatric sepsis case, with the team leader either physically present or participating via videoconference. Data on team performance, clinical skills, and perceptions of teamwork and leadership will be collected through validated tools and surveys. The results could provide guidance on best practices for telemedicine implementation and its effects on teamwork and care quality in pediatric emergencies.

1. ALERT Presentation:
Impact of physical presence vs.
telepresence of team leader on teamwork
and communication in simulated pediatric
emergency cases: an RCT
Lucas Butler
Yale School of Medicine
INSPIRE @ IMSH 2016 – San Diego, CA / USA
International Network for Simulation-based Pediatric Innovation, Research and Education

2. • Telemed consults used in critical community ED peds cases
• Little front-end research guiding implementation and best
uses for this technology
• Paucity of rigorous research on impact of telemed on quality
of care in peds emergency cases
• No research on teamwork—crucial contributor to outcomes—
in peds emergency telemed cases (despite clear change in
team dynamic when team leader physically absent)
International Network for Simulation-based Pediatric Innovation, Research and Education
Background

3. • P: resident peds and EM teams (Sr., Jr.,
intern/PA/RN)
• I: team leader (Sr. resident) on videoconference
• C: team leader in room (normal sim)
• O: 1°STAT human factors score
2°STAT clinical skills score
3°teamwork/workload self-assessments
International Network for Simulation-based Pediatric Innovation, Research and Education
PICO / Research Question

4. • Recruit 18 teams of 3-4 resident/PA/RN
• Randomize. Intervention= TL on videoconference
(multiple views of room and monitors)
International Network for Simulation-based Pediatric Innovation, Research and Education
Approach / Design

5. • Demographic data survey
• Run sim for which STAT validated (see next slide)
• Scripted debriefing, gather qualitative data on
perspectives of telemed’s
impact on teamwork
• Self-assessment surveys:
teamwork & workload
• Review case videos, score
with STAT tool
International Network for Simulation-based Pediatric Innovation, Research and Education
Approach / Design cont.

6. • Simulation:
– Scenario: 2 y.o. in septic shock with subsequent apnea and Vfib
– Location: Yale Sim Center (AV control room, sim technician)
– Manikin: Laerdal SimBaby
– Equipment: B-Line SimCapture
(bird’s eye, room, monitor views)
• Data Collection Instruments:
– STAT tool
– Demographic data survey
– Post-sim subjective assessments of
leadership and overall teamwork
International Network for Simulation-based Pediatric Innovation, Research and Education
Design—Case & Instrument

7. • Independent two-sample t-tests
• Calculated sample size n=18
• Gather qualitative data during scripted debriefing
International Network for Simulation-based Pediatric Innovation, Research and Education
Methods—analyses

8. • H 1: Teamwork improved due to:
+ Increased team member idea-sharing & engagement in decision-making
+ More “huddles” and sharing of mental model
+ Increased verbal communication, improved closed-loop communication
- Decreased non-verbal communication
• H 2: Quality of care increased
+ Decreased TL task fixation/distractions
+ Reduced team anxiety
- Reduced team structure/clearly defined roles given lack of TL physical presence
- Most skilled person physically outside room
• H 4: Decreased self-reported TL leadership skills by TL & team
International Network for Simulation-based Pediatric Innovation, Research and Education
Hypotheses

9. • ALERT Presentation—Jan 15, 2016
• Grant Proposal (if applicable)—N/A
• IRB Submission—10/30/2015
• Recruitment/Data Collection—pilot Nov 16, testing Jan-Mar ‘16
• Data Analysis—March-April 2016
• Abstract Presentation—May 2016
• Manuscript Preparation—June 2016
International Network for Simulation-based Pediatric Innovation, Research and Education
Timeline

10. 1. Proper choice of data collection tools/forms?
2. Will this work generalize to non-pediatric
cases and non-resident providers?
3. Right # of data collection forms to amass
sufficient data without overburdening subjects?
International Network for Simulation-based Pediatric Innovation, Research and Education
4 questions to improve study

11. At INSPIRE @ IMSH 2016:
Feedback/direction from industry experts, network
with others interested in telemed/sim/teamwork
In 2 months: Introduction & methods written,
enrolling subjects, all study elements in place
International Network for Simulation-based Pediatric Innovation, Research and Education
Goals to accomplish

12. Lucas Butler
Yale Medical School
lucas.butler@yale.edu, 203-215-1111
International Network for Simulation-based Pediatric Innovation, Research and Education
Contact Information