Implementation of the 10 minute meeting: a user s guide

Transcription

1 Implementation of the 10 minute meeting: a user s guide How a short daily meeting can save lives by helping emergency teams work together more effectively. What s the issue? A critical care outreach team (CCOT) is called, on average, to between three and five medical emergency/cardiac arrest calls every day. The medical emergency team (MET) consists of a medical registrar, two foundation year 2 doctors, one foundation year 1 doctor, an intensive care registrar, a CCOT member and a porter. The cardiac arrest team (CAT) has the same team members minus an intensive care registrar. An anaesthetist and a resuscitation officer will also join this team. These groups of medical personnel work in the hospital in their own teams. They may be unaware who is part of the MET or CAT, what role they play, who takes the lead, what skills each other have and what is expected of them. 1 in 400 million When an emergency call is made, the doctors carrying the emergency bleep are scrambled from across the hospital. As a team, they first meet over a sick patient, usually at different times. The nurse caring for the patient will hand over between two and three times to different members of the team if there is no leader allocated. This waters down the handover and information may get lost or missed. The team then has to organise itself Who is leading? Who takes blood? Who gets a line in? Who are you? There s a 1 in 400 million chance of the same team working together again.

2 Effective team working involves: Clear objectives Clear communication Clear leadership Participation Familiarity between team members Support from each other Results Results from hospital based health teams demonstrate that working in teams creates significantly less stress than working in looser groupings. Medical emergencies and cardiac arrests are low volume, high risk events. Many team members will only experience these situations a few times each year. With little access to simulation and working with difference specialities (ITU, medicine, nursing and anaesthetics) it is little wonder that people are stressed in these situations. If a team has lower levels of stress, there is a higher level of participation within the team. If the team has a clear goal, an assertive leader and clear expectations the quality of care is increased, therefore patient safety is improved. None of these factors existed in the original MET/CAT. So the team asked itself: Is patient safety at risk? Team members looked at how to reduce risk and came up with the 10 minute meeting. How did the idea come about? Claire Cox, Critical Care Outreach Sister, Brighton and Sussex University Hospitals NHS Trust (BSUH), attended an innovation forum where delegates were asked what idea would make your job easier? The problem with MET/CAT immediately sprang to mind along with a simple solution: by meeting up at the beginning of the shift and introducing ourselves! Implementation The Outreach team, led by Claire, took on responsibility for implementing the initiative. They are the only consistent member of the MET/CAT who attend all calls and they don t rotate through different hospitals or teams. As a team, they are also exposed to medical emergencies and cardiac arrests every day that they work so they are well experienced.

3 Step by step: how to implement the 10 minute meeting 1. Gain support from CCOT manager and team members. 2. Gain support from the acute medical consultant responsible for the rotation/learning of the foundation doctors in medicine. 3. Set out a clear agenda for the 10 minute meeting. 4. Find out what time doctors start their shift. 5. Where do they meet? 6. What is the current handover routine? 7. Find a place to meet preferably where they meet to swap bleeps (as they will not come to you). 8. Arrange a convenient time to have the meeting. 9. Inform key stakeholders Lead intensive care consultant, anaesthetic lead for trainees, and medical trainee lead consultant for medicine. Outline the problems, benefits and outcomes of meeting - explain it is 10 minutes only. 10. Start off weekdays only. 11. Choose a date go ahead.

4 How the meeting is run We ve outlined below the typical format and content that Claire would follow for a meeting. If there is a second call, this meeting would follow the first call meeting, dependent on what the first call was and how the team was split. Person running the meeting introduces themself and outlines why the meeting is important patient safety, reducing your stress level, getting to know each other, who is part of the team etc Ensure that the white board is up to date with all roles and names. This ensures you have a full team and highlights anyone sick or missing. Make introductions, every time whether they know each other or not. From this point it is best to refer to people as their name not job title, as it helps promote familiarity and rapport. In the beginning Outreach could lead the meetings, but once established the med reg leads, as they will be leading the emergency. You can hand the proforma to the med reg and they go from there. Allocate roles: Team leader Med reg usually does this, but is an SHO needing to step up with support? Remind the team that hand over will take place once team leader arrives. Cannulation Always ask if you are not able to cannulate after two attempts, please escalate this to team leader, do you know where the EZIO is kept and how to use it? A learning opportunity arises here and outreach will offer support in this. ABG Ensure person allocated is able to perform a femoral stab, many F1s will not be able to do this. Airway Ensure everyone is aware that the anaesthetist attends cardiac arrests only. Inform everyone of the process of getting airway support if at a MET call. ABCDE assessment allocate usually to an F2 Defib, timing, getting notes usually outreach to do, unless there are learning needs. Ask: Can everyone fulfil their role? Has everyone been to an emergency before? A hot debrief (if able) will happen post cardiac arrest. Remind the team that the ITU Dr may not be airway trained. Ask the leader what happens if there is a second arrest/met call at the same time? The team will usually split it does depend on the situation. The team needs to know who is ALS trained and is able to attend the second call and support provided by resus officer/outreach teams. Any changes to hospital layout are mentioned, lifts that are broken etc Any questions?

5 Keep the meeting short, snappy and on time. You may want to ask a question such as where is the adrenaline kept? just to make sure people are listening. Overcome the challenges Time of meeting Each group of doctors starts at different times and hands over in different places so finding a time convenient for all is not always easy. Setting the meeting time for 09:00 will mean the majority of the doctors should be able to attend. Engagement The initiative needed senior endorsement and support. BSUH used the Trust s Innovation Forum as a way of recruiting senior and wider workforce support. Engaging junior doctors on the MET/CAT should be straight forward because they witness first-hand the benefits of the meeting. Engaging other stakeholders can be more challenging as they think about the other commitments that junior doctors have the pain round, ward rounds etc. Finding opportunities to engage with them is really important: presenting at an innovation forum creates the opportunity for discussion, enabling dialogue between them and their peers across different specialities. This also allows the juniors to be released for 10 minutes from the pain round and the ward rounds. We have tried before it doesn t work This is a phrase you may hear from both senior nurses and consultants. Yes, this may have been tried before but who tried it? Why did they try it? And why didn t it work? Any surprises? The 10 minute meetings create the opportunity to ask simple questions such as has everyone been to a cardiac arrest/medical emergency call before? It is not uncommon for junior doctors to have little experience of these situations, and it can be problematic when allocating roles because doctors may not have the necessary experience to complete a task. Using an intraosious needle or doing a femoral stab for an arterial sample is a common task junior doctors can t do, and cannulation or arterial blood gas sampling in a moribund patient in a high stress situation can be difficult.

6 The 10 minute meeting provides the opportunity to discuss the expectations of each member of the team and the tasks they need to perform: team leader, cannulator, arterial blood sampling, defibrillation, chest compressions etc. By asking these simple questions and addressing these common challenges, it provides a forum for team members to state their limitations. This is then seen as a learning opportunity when called to a cardiac arrest or medical emergency. It is significantly less stressful knowing that they will be given support to complete their task. Hot debriefing should take place after each cardiac arrest to ensure everyone knows what went well and what can be improved. Does it work? Initiation of the meeting was started 18 months ago at BSUH. It began with a meeting Monday to Friday across one of the trust s two sites. It is now running seven days a week across both sites. With the help of Kent Surrey Sussex Academic Health Science Network, research into how this meeting is benefiting patients is being undertaken. Spreading best practice: next steps The MET/CAT meeting is now part of the Acute floor meeting held in A&E. A&E has now adopted a similar style meeting for the Trauma team briefing. The meeting within hospital at night across the two sites needs to be initiated. Until Outreach is 24/7 at both sites, this may be difficult. Promote this idea to other Trusts. Make this meeting part of everyday hospital life. When doctors rotate they can expect this in every Trust. With robust evidence that this meeting is crucial to the outcome of our sickest patients, go to the resuscitation council and make this meeting part of the guidelines. Need more information? To find out more about the 10 minute meeting initiative, or to let us know how you re getting on implementing the meetings, please psc@kssahsn.net