Rupture EVAR Formula 1 style: it is all about team training - - PowerPoint PPT Presentation

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Rupture EVAR Formula 1 style: it is all about team training - - PowerPoint PPT Presentation

Aug 21, 2023 183 likes •412 views

Rupture EVAR Formula 1 style: it is all about team training www.critical-issues-congress.com Di Disclosures Speaker name: Colin Bicknell. I I ha have the foll ollowing po potentia ial l conflic icts of of interest to to report:

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SLIDE 1

www.critical-issues-congress.com

Rupture EVAR Formula 1 style: it is all about team training

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SLIDE 2

Di Disclosures Speaker name: Colin Bicknell. I I ha have the foll

  • llowing po

potentia ial l conflic icts of

  • f interest to

to report: Consulting – Medtronic, Bolton Medical, Orzone Institutional level funding, Orzone

Imperial College

London

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SLIDE 3

CRISIS TRAINING

Imperial College

London

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SLIDE 4

TRAINING – THE WHOLE PATHWAY - DECISIONS

Imperial College

London

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SLIDE 5

SAFETY ATTITUDE QUESTIONAIRES - CULTURE

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% A F C G D H J B E I Vascular

  • perating

department

The proportion of respondents with positive perceptions of teamwork in ten vascular

  • perating departments

Distribution of teamwork scale- scores across vascular

  • perating departments at ten

different hospitals

Lear R, Godfrey A, Riga C, Bicknell C

Imperial College

London

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SLIDE 6

ERRORS OCCURING DURING SURGICAL PROCEDURES

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Increased errors in

  • Endovascular aortic procedures
  • New technology used
  • Complex procedures

6.5% of cohort directly harmed by our definition

[7 communication errors, 4 technical errors, 3 unanticipated problems relating to patient’s anatomy]

Imperial College

London

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SLIDE 7

TRAINING - AGGREGATED MARGINAL GAINS THROUGH THE WHOLE PATHWAY

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“The principle comes from the idea that if you break down everything you can think of that goes into riding a bike and then improve it by 1% you will get a significant increase when you put them all together”

Dave Brailsford, UK cycling performance director

Should we all be looking to aggregated marginal gains?

Imperial College

London

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SLIDE 8

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THE YERKES-DODSON HUMAN PERFORMANCE AND STRESS CURVE

Imperial College

London

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SLIDE 9

SURGEON COGNITIVE LOAD

Heart Rate

p=0.002

Bakhsh A, Bicknell C, Martin G, Riga C. STRES Study: STress Response in Endovascular team Simulation, VSGBI 2017

Mental rehearsal High fidelity immersive team simulation Technical knowledge Technical simulation

Mirrored when measuring sympathetic response and NASA-TLX scores and related to technical performance

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IMPACT OF MISPLACED TRUST IN PUBLIC PREPAREDNESS

Imperial College

London

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SLIDE 11

Imperial College

London

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SLIDE 12

TRAINING IN FULLY IMMERSIVE SIMULATION

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SLIDE 13

CONSTRUCT AND FACE VALIDITY

RUPTURED IRAAA EMERGENCY CASE SIMULATION.

Imperial College

London

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SLIDE 14

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ASSESSMENT

Off line video analysis 3 observers

SIMULATION 2

Simulated angiography suite team simulation with standard stressors randomly selected

DEBRIEF

Video playback Peer to peer feedback Standardised team/leadership training

SIMULATION 1

Simulated angiography suite team simulation with standard stressors

TECHNICAL INSTRUCTION

Indications and principles of TEVAR Technical steps Technique

TRAINING OF LEADERSHIP SKILLS

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SLIDE 15

PATIENT SPECIFIC REHEARSAL

Variable Errors Intervention group

(95% CI)

Errors Control group

(95% CI)

Difference intervention vs. control group 95% confidence interval p-value* p-value multivariate analysis‡ Major errors

Complete procedure

0.08

(0.03 to 0.21)

0.34

(0.21 to 0.55)

  • 76.5%
  • 92.1 to -30.1%

0.009 0.009 Minor errors

Complete procedure

3.14

(2.67 to 3.67)

4.24

(3.71 to 4.85)

  • 25.9%
  • 39.8 to -9.0%

0.004 0.002

  • 1. Dicom
  • 2. 3D recon
  • 3. VR Sim
  • 4. Real case

Real Case in Angiosuite Simulated Case in SOS

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SLIDE 16

Imperial College

London

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SLIDE 17

TEAM TRAINING

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  • Multidisciplinary in teams
  • Structured
  • Routine
  • Emergency
  • Reactive
  • Entire pathways of care

Device specific

Mentored

Imperial College

London

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SLIDE 18

CRISIS TRAINING – ILIAC RUPTURE

Imperial College

London

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“on the night of the team training day, I was asked to assess a patient with paraplegia with a spinal drain ... effective management using new knowledge and skills from the course led to a reversal of the paraplegia”

VASCULAR NURSE

DEALING WITH SERIOUS INCIDENTS

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HELPING OUR TEAMS TRANSFORM

  • Stream 1: MDT simulation
  • Stream 2: Human Factors learning
  • Stream 3: In situ Coaching and Learning

Imperial College

London

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SLIDE 21

KEY THEMES

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F1 style rAAA is a noble aspiration …in reality it isn’t going to work like this but training teams will likely bring significant benefits, focusing on:

  • TEAMS
  • CULTURE
  • WHOLE PATHWAY
  • IMMERSIVE TRAINING
  • CASE SPECIFIC
  • CRISIS TRAINING
  • A FOCUS ON TRAINING AFTER

ERROR

Imperial College

London

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SLIDE 22

RESEARCH TEAM

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With many thanks to….

Krishna Moorthy Chris Norton Charles Vincent Ara Darzi Mo Hamady Celia Riga …and many more Mentice Orzone Medtronic NIHR Circulation Foundation Mostafa Albayati Shaneel Patel Abi Morbi Rachael Lear Dean Godfrey Anoo Ramjeeawon Dania Nafisee Chris Pettengell Anna Sharrock Manj Gohel Isabelle Van Herzeele Liesbeth Descender Heidi Martens Alex Rolls Nung Rudarakanchana Anisha Perera Ruwan Weerakkody Andrew Batchelder All of the LEAP study collaborators

Imperial College

London