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Using High-Reliability Organization principles to improve communication during high-fidelity trauma simulation
Shea C Gregg, Alisa Savetamal, *Kristen Glasgow, Roselle E Crombie, Walter Cholewczynski, *Liana Kappus, *Cheryl Mayeran, *Paul Possenti, *Rockman Ferrigno, Nabil A. Atweh
Bridgeport Hospital, Yale-New Haven Health System, Bridgeport, CT

Objective: To incorporate High-Reliability Organization(HRO) principles into a trauma simulation curriculum and measure their impact on resident leader communication. Design: Before-after trial. Setting: General Surgery training site; Level II trauma center Participants: General surgery residents serving as team leader for trauma simulations Interventions: A previously-established, team leadership evaluation tool used in actual trauma resuscitations was used in high-fidelity trauma simulations. This tool listed thirty actions demonstrating the ACGME core competencies of patient care, medical knowledge, communication/professionalism, practice-based learning, and systems-based practice. These actions were graded on a Likert scale of 1(poor) to 5(exceptional). Following system-wide education in HRO principles, the following were included in the simulation curriculum: CHAMP(Communicate clearly/Check backs; Hand-off effectively; 
Attention to detail; Mentoring with accountability; Practice and accept questioning attitude); Closed-loop communication; Using “Stop the Line” for safety concerns. Phase 1 of the monthly simulation curriculum provided evaluation tool feedback on communication performance(4/2014-12/2014). The HRO principles were incorporated in Phase 2(8/2015-3/2016). This study was IRB review exempt. Main outcome measure: Communication/professionalism scores were evaluated to quantify the impact of HRO training on the simulation curriculum. Results: During the study period, 13 resident team leaders were evaluated, seven in Phase 1, and six in Phase 2. Average aggregate communication/professionalism scores were significantly improved(2.5 vs. 3.8, p=0.003). Significant score improvement was noted in role assignment, check back verification, effective decision communication, team member engagement in decisions, and respectful communications(p≤0.05). No significant score changes were observed in team leader establishment, situational awareness update inquiries, quick/firm decision communication, error recognition/correction, and constructive conflict resolution(p≥0.05). Conclusion: Structured, HRO training can improve communication/professionalism scores on a resident team leadership evaluation tool used in high-fidelity trauma simulation.

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