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

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: Consulting – Medtronic, Bolton Medical, Orzone Institutional level funding, Orzone Imperial College London

CRISIS TRAINING Imperial College London

TRAINING – THE WHOLE PATHWAY - DECISIONS Imperial College London

SAFETY ATTITUDE QUESTIONAIRES - CULTURE Distribution of teamwork scale- scores across vascular operating departments at ten different hospitals Lear R, Godfrey A, Riga C, Bicknell C 100% 90% 80% 70% 60% 50% 40% The proportion of respondents 30% with positive perceptions of 20% teamwork in ten vascular 10% Imperial College 0% operating departments London A F C G D H J B E I Vascular� operating� department

ERRORS OCCURING DURING SURGICAL PROCEDURES 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 6

TRAINING - AGGREGATED MARGINAL GAINS THROUGH THE WHOLE PATHWAY Should we all be looking to aggregated marginal gains? “ 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 Imperial College London 7

THE YERKES-DODSON HUMAN PERFORMANCE AND STRESS CURVE Imperial College 8 London

SURGEON COGNITIVE LOAD Heart Rate Mental rehearsal Technical knowledge Technical p=0.002 simulation High fidelity Mirrored when measuring sympathetic response and NASA-TLX immersive scores and related to technical performance team simulation Bakhsh A, Bicknell C, Martin G, Riga C. STRES Study: STress Response in Endovascular team Simulation, VSGBI 2017

IMPACT OF MISPLACED TRUST IN PUBLIC PREPAREDNESS Imperial College London

Imperial College London

TRAINING IN FULLY IMMERSIVE SIMULATION

CONSTRUCT AND FACE VALIDITY RUPTURED IRAAA EMERGENCY CASE SIMULATION. Imperial College London

TECHNICAL INSTRUCTION TRAINING OF LEADERSHIP SKILLS Indications and Technical steps Technique principles of TEVAR SIMULATION 1 Simulated angiography suite team simulation with standard stressors DEBRIEF Standardised Video playback Peer to peer feedback team/leadership training SIMULATION 2 Simulated angiography suite team simulation with standard stressors randomly selected 14 ASSESSMENT Off line video analysis 3 observers

PATIENT SPECIFIC REHEARSAL Simulated Case in SOS Real Case in Angiosuite 2. 3D recon 3. VR Sim 4. Real case 1. Dicom Errors Errors Difference intervention vs. p-value multivariate Variable Intervention group Control group 95% confidence interval p-value* control group analysis‡ (95% CI) (95% CI) Major errors 0.08 0.34 -76.5% -92.1 to -30.1% 0.009 0.009 Complete procedure (0.03 to 0.21) (0.21 to 0.55) Minor errors 3.14 4.24 -25.9% -39.8 to -9.0% 0.004 0.002 Complete procedure (2.67 to 3.67) (3.71 to 4.85)

Imperial College London

TEAM TRAINING • Multidisciplinary in teams • Structured • Routine • Emergency • Reactive • Entire pathways of care Device specific Mentored Imperial College London 17

CRISIS TRAINING – ILIAC RUPTURE Imperial College London

DEALING WITH SERIOUS INCIDENTS “ 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

HELPING OUR TEAMS TRANSFORM • Stream 1: MDT simulation • Stream 2: Human Factors learning • Stream 3: In situ Coaching and Learning Imperial College London

KEY THEMES 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 21

RESEARCH TEAM With many thanks to…. Mostafa Albayati Krishna Moorthy Shaneel Patel Chris Norton Abi Morbi Charles Vincent Rachael Lear Ara Darzi Dean Godfrey Mo Hamady …and many more Anoo Ramjeeawon Celia Riga Dania Nafisee Chris Pettengell Anna Sharrock Manj Gohel Isabelle Van Herzeele Mentice Liesbeth Descender Orzone Heidi Martens Medtronic Alex Rolls NIHR Nung Rudarakanchana Circulation Foundation Anisha Perera Ruwan Weerakkody Andrew Batchelder All of the LEAP study collaborators Imperial College London 22