Retentive learning of closed-loop communication -a post simulation focus group interview study

Background: In-situ simulation trains human factors in medicine. The Bern University Hospital’s Paediatric Intensive Care Unit (PICU), Switzerland, launched an interprofessional in-situ simulation in 2017 focusing on closed-loop communication (CLC). An observational before-and-after study measured application and sustained use of CLC in daily clinical practice of PICU-nurses. Answers to commands improved after simulation, and were sustained for a 3-month observation period, especially in critical, noisy, and stressful situations. Interviewing nurses, who participated in the previous simulation, this focus-group study investigated their thoughts, feelings and attitudes with the goal of deepening our knowledge about the learning of communication patterns during simulation, and which factors foster retention of competence.Summary of Work: 10 nurses from the former simulation study agreed to participate in focus-group interviews about one year after. Video-recorded data was anonymised and transcribed. After member checking, we analysed the data qualitatively (MaxQDA2018; Standard-Version 18.1.1, VERBI Software, Berlin, Germany), and performed a thematic analysis (Braun 2006 77-101). We generated initial codes and collated them into properly named themes. At the conference, the final result and report of the thematic analysis will be presented.Summary of Results:Most participants transferred the learnt communication skills from the simulation environment to their clinical daily life; specifically they closed the communication cycle by responding consciously if a “call-out” reached them. They highly valued the increased self-awareness of their communication habits with all the team members, not just with the nurses. Performed “Team-Time-Outs” (TTO) and observed CLC were considered fostering factors to improve their own communication skills. A “critical-mass effect”was described. As soon as most nurses completed the simulation, communication at the PICU improved observably. The study personnel was not an influencing factor on communication patterns.Discussion and Conclusions:This focus group interview study revealed factors that contributed to increased and sustained use of CLC after interprofessional simulation. Awareness of the answering process and structured exchange (TTO) fostered their communication, and was seen to improve the PICU-team spirit and collaboration between physicians and nurses.Take-home Messages: Interprofessional in-situ simulation improves closed-loop communication patterns in PICU clinical daily life.