Effectiveness of In-Situ Simulation Training in Adult Non-Trauma Resuscitation: A Comparison of ISS and OSS Team Performance Using the A-C-L-S Model

Official title

Effectiveness of In Situ and Off-site Simulation on A-C-L-S Teamwork Model Implementation for Adult Non-trauma Resuscitation: A Two-group Pre-post Study

Overview

This study employed a two-group non-randomized pre-post design to evaluate the effectiveness of interprofessional ISS training over one year at the National Taiwan University Hospital Yunlin Branch. The research implements the A-C-L-S teamwork model for adult non-trauma resuscitation teams, comparing the impacts of ISS versus Off-site Simulation (OSS) on team performance. Emergency department teams are assigned between two campuses: ISS at Douliu campus and OSS at Huwei campus. Each training session follows a standardized protocol: twenty-minute briefing, ten-minute high-fidelity simulation, and thirty-minute structured debriefing. The assessment utilizes the Team Emergency Assessment Measure (TEAM) scale for non-technical skills evaluation, alongside secondary outcomes including resuscitation process, CPR quality, and patient outcome indicators. External ACLS instructor-qualified experts conduct blinded evaluations of recorded scenarios to analyze team performance and training transfer. The study aims to deliver benefits across three dimensions: establishing evidence-based education models to enhance resuscitation team efficiency and patient outcomes; strengthening institutional teaching and research capacity through standardized assessment mechanisms; and developing systematic data collection processes with localized quality indicators for early error detection and improvement.

Interventions

• Other In-situ Simulation (ISS) Training
  The ISS group will undergo high-fidelity simulation training conducted in a real clinical environment, such as the emergency department. This training will involve a structured scenario with a briefing (20 minutes), a simulation exercise (10 minutes), and a debriefing session (30 minutes). The goal is to enhance teamwork and improve non-technical skills (e.g., communication, coordination) during adult non-trauma cardiac arrest resuscitation. The training follows the A-C-L-S (Airway-Circulation-L
• Other Off-site Simulation (OSS) Training
  The OSS group will participate in simulation training at a dedicated simulation center, using high-fidelity mannequins and equipment. Similar to the ISS group, the training involves a briefing (20 minutes), a simulation scenario (10 minutes), and a debriefing (30 minutes). However, this training is conducted in a controlled environment away from the real clinical setting. The training follows the same A-C-L-S model for team role structuring and focuses on improving teamwork and technical skills

Primary outcome measures

• Non-Technical Skills Evaluation Using the TEAM Scale [Time frame: Through study completion, an average of 1 year]

Secondary outcome measures (3)

• Time to Key Resuscitation Interventions [Time frame: Through study completion, an average of 1 year.]
• CPR Quality - Chest Compression Fraction (CCF) [Time frame: Through study completion, an average of 1 year.]
• Patient Outcomes - Rate of Return of Spontaneous Circulation (ROSC) [Time frame: Through study completion, an average of 1 year.]

Eligibility criteria

Inclusion criteria

The Adult Non-Traumatic Resuscitation Teams in the emergency departments of the Douliu and Huwei (branches consist of approximately 2 to 7 healthcare professionals per team). The healthcare professionals include attending physicians, resident physicians, specialized nurses, and registered nurses from the National Taiwan University Hospital system.

Exclusion criteria

• Medical students and emergency medical technicians (EMTs) observing resuscitation in the emergency room.
• Healthcare professionals who have not obtained a valid ACLS certification.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Non-randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Other

Study locations

Taiwan · 1 center

• National Taiwan University Hospital Yunlin Branch (Douliu) — Douliu

Publications

• Mei Q, Zhang T, Chai J, Liu A, Liu Y, Zhu H. Application of In Situ Scenario Simulation in Advanced Cardiac Life Support Training for Eight-year Medicinal Students. Medical Journal of Peking Union Medical College Hospital. 2023;14(3):660-664. doi:10.12290/xhyxzz.2022-0676
• Cooper S, Cant R, Connell C, Sims L, Porter JE, Symmons M, Nestel D, Liaw SY. Measuring teamwork performance: Validity testing of the Team Emergency Assessment Measure (TEAM) with clinical resuscitation teams. Resuscitation. 2016 Apr;101:97-101. doi: 10.1016/j.resuscitation.2016.01.026. Epub 2016 Feb 11. PMID 26875992
• Maignan M, Koch FX, Chaix J, Phellouzat P, Binauld G, Collomb Muret R, Cooper SJ, Labarere J, Danel V, Viglino D, Debaty G. Team Emergency Assessment Measure (TEAM) for the assessment of non-technical skills during resuscitation: Validation of the French version. Resuscitation. 2016 Apr;101:115-20. doi: 10.1016/j.resuscitation.2015.11.024. Epub 2015 Dec 17. PMID 26708450
• Cooper S, Connell C, Cant R. Review article: Use of the Team Emergency Assessment Measure in the rating of emergency teams' non-technical skills: A mapping review. Emerg Med Australas. 2023 Jun;35(3):375-383. doi: 10.1111/1742-6723.14184. Epub 2023 Feb 27. PMID 36849717
• Smidt A, Balandin S, Sigafoos J, Reed VA. The Kirkpatrick model: A useful tool for evaluating training outcomes. J Intellect Dev Disabil. 2009 Sep;34(3):266-74. doi: 10.1080/13668250903093125. PMID 19681007
• Cortegiani A, Ippolito M, Abelairas-Gomez C, Nabecker S, Olaussen A, Lauridsen KG, Lin Y, Sawyer T, Yeung J, Lockey AS, Cheng A, Greif R; International Liaison Committee on Resuscitation Education, Implementation and Teams Task Force (EIT) Task Force. In situ simulation for cardiopulmonary resuscitation training: A systematic review. Resusc Plus. 2025 Jan 3;21:100863. doi: 10.1016/j.resplu.2024.10 PMID 39897060
• Riley W, Davis S, Miller K, Hansen H, Sainfort F, Sweet R. Didactic and simulation nontechnical skills team training to improve perinatal patient outcomes in a community hospital. Jt Comm J Qual Patient Saf. 2011 Aug;37(8):357-64. doi: 10.1016/s1553-7250(11)37046-8. PMID 21874971
• Hunt EA, Hohenhaus SM, Luo X, Frush KS. Simulation of pediatric trauma stabilization in 35 North Carolina emergency departments: identification of targets for performance improvement. Pediatrics. 2006 Mar;117(3):641-8. doi: 10.1542/peds.2004-2702. PMID 16510642

Identifiers

NCT: NCT07358793 · 202510146RIND

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗