SC Critical Event Team Training
"Turning a Team of Experts into an Expert Team"
This is your first day working in Kaiser's brand new Emergency Department (ED) in Santa Clara . "The Mother of this 4-month-old baby reports that he just had his first seizure while her boyfriend was baby sitting him," reports the Triage Nurse. As you assess the baby, lots of questions run through your mind, including:
- Where is an oxygen mask that will fit a 4-month-old baby?
- How do I call other members of the team for help if I need it?
- Where is the Broselow tape to measure the baby in case I need to give emergency drugs?
- Where the crash cart is located?
- Can I operate all the equipment in the room to safely care for this baby?
All these questions, and many more, were answered for the entire Emergency Department team of Staff and Resident Physicians, Registered Nurses, Respiratory Therapists, ED technicians, and Unit Assistants during Critical Event Team Training (CETT) in June. The three-day event was organized to help staff prepare for their move into Kaiser's new Santa Clara facility on August 7 th . During the Training, over 200 physicians and staff participated in 54 Code Blue scenarios over a three-day period. Dr Yi-Mei Chng, Santa Clara ED Physician and this CETT Program Supervisor, and Dr Paul Preston, San Francisco Anesthesiologist, identified the goal of the CETT in the new Santa Clara ED as "Turning a Team of Experts into an Expert Team."
Liz Bauer, Director of Santa Clara's ED, organized the CETT for the new 
ED at Santa Clara primarily to give the physicians and staff the opportunity to learn about their new ED environment before the move to the new Homestead campus. Several systems problems were identified during the three days of CETT, allowing the challenges to be met before patients actually arrive in the ED. "Physicians and staff have been very enthusiastic about this training! They have entered into the scenarios just like for an actual patient," Liz reported. Assistant Manager Lisa Connelly also was involved with the extensive planning necessary to organize such a large-scale event. During the scenarios, she observed the action to identify work flow and practice issues. Particularly appreciated by all was the opportunity to actually identify where equipment and supplies are located in the new environment and how the team can function most effectively there.
As the above scenario with the 4-month-old baby unfolded, staff discovered how to mobilize the team in an emergent situation in the new ED, operate the equipment in the room, locate the nearest crash cart and find age-specific emergency drugs and supplies in this new environment. While the main focus of this CETT was to familiarize the ED team with the new environment, each member of the team had an opportunity to actually perform his/her usual role in the safe environment of a Team Training Event. Using high-fidelity manikins, the staff could listen to heart, breath and abdominal sounds; monitor changing heart rhythms, pulses and oxygen saturation levels; and observe pupil changes. Scenario leaders could control the manikin's responses through the computer connected to the manikin, so that the manikin simulated the actual response of a human to interventions such as providing oxygenation, administering IV drugs and fluids, and cardioverting or defibrillating the manikin. The effect of delaying or failing to provide these interventions could also be demonstrated. Skills such as endotracheal intubation and intraosseal IV insertion for the baby were practiced by the physicians. Skills of peripheral and central IV starts can also be practiced on these manikins, though the staff did not practice these skills during this particular Training. Physicians and staff also used the new forms and order sets that they will be using when they move into the new facility on August 7 th , which helped familiarize them with the new paperwork.
Scenario leaders Drs. Paul Preston, Jeff 
Convissar, Haydn Leung and Jim Healzer emphasized the importance of effective communication as team members enter the room during the emergency, as the patient condition changes and as interventions are ordered and completed. Throughout the CETT, SBAR method of communications was greatly encouraged by all event leaders. Physicians practiced giving clear orders; staff practiced cross checking orders by repeating orders back before implementing the orders and after implementation was complete. Team members were encouraged to "Think out loud" so that the Team "stayed on the same page" throughout the emergency. Team members discovered that announcing the intention to start an intervention helped prevent duplication of efforts to complete the same task. Verbally confirming that the intervention was complete let all the team members know that the task was complete.
Nurse Educators Lani Secker and Robert Jackson worked with team members to optimize learning during the exercise. The events were video taped so that team members could review the scenario during the debriefing phase of the CETT. Event organizers emphasized that the debriefing phase critiques performance, not the individual person. Initially, what went well during the scenario was identified by the participants. Then what could be better managed was discussed. System problems were identified and reported to ED Director Liz Bauer. Communication errors were discussed and more effective means of communicating were identified. The most effective manner of managing patient families during a Code was discussed. While watching the scenarios on video tape, team members were able to see how calm, clear communications allowed all team members to work better as a team.
The Critical Event Team Training for 
Kaiser-Santa Clara's new Emergency Department required extensive preparation and planning by a team of highly skilled professional health care providers. The payoff is an Expert Team for health care delivery at Kaiser-Santa Clara's new Emergency Department.