Multi-disciplinary team-based simulation training in acute care settings: a systematic review of the impact on team performance

Background: Teamwork plays an essential role in providing quality health care and ensuring good outcomes and safe
practices in any health care system. This has been demonstrated in several studies in emergency care where resuscitation
teams perform at a high level to achieve desired outcomes in life-threatening situations. Simulation has been identified
as an effective way of improving team performance skills, especially in acute care settings where team dynamics change
rapidly and require good collaboration. In addition to clinical competence, the members of the team need to be
conversant with non-technical skills such as team leadership and communication. Methods: The MEDLINE,
EMBASE and Cochrane Library databases were searched for original articles from the last 20 years investigating
team performance in multi0disciplinary team-based simulation training in acute care settings. The research questions
were developed using the participants, intervention, comparisons, outcome (PICO) framework. The review was designed
and reported in accordance with PRISMA guidelines. The articles were then assessed by independent reviewers using
the Critical Appraisal Skills Program (CASP) to standardize the assessment process. Results: Of the 1260 articles
identified, 12 primary research articles representing a variety of team-based simulation training in various acute care
settings were included. The studies were published between 2002 and 2020 and included 679 participants 418 years of
age. All articles were original research papers with a combination of pre-/post-test, observational, randomized, and
prospective designs; 11 were single-site studies and one was a multi-site study. Six studies used a pre-/post-test
interventional method, four used a post-interventional method and one was an observational study. One study used
a prospective blinded controlled observational method. Most of the articles reviewed did not provide high-level evidence
and the control aspect of PICO was not applied because the review focused mainly on the intervention and outcome
with no comparator. This study shows that 72.2% of the reviewed articles demonstrated a positive impact of team-based
simulation training on team performance. Discussion: This review has demonstrated some evidence that team-based
simulation training used in various emergency and acute care clinical settings does improve team performance.
However, how that translates to improvement in patient safety and clinical outcomes was not fully addressed by
most of the articles reviewed and other previous studies. Simulation enhances team training; the evidence to support
multi-disciplinary team training is positive although limited and will require further research to fully develop and
validate simulation-based team training programmes.