Critical Events Team Training: Ready CETT Go to Simulation Success

Critical Event Team Training is one of  a  multitude of approaches utilized to enhance safety in the Perinatal setting, borrowed from many theories, disciplines, and industries. It relies on the use of human factors techniques and systems improvements. The concept of high reliability was borrowed from the United States Navy, NASA, and the aviation industry . What these organizations have in common is the responsibility for highly complex systems that strive to sustain zero percent error.  These organizations  not only recognize the criticality of quality performance, they also assume  the likelihood of human error. To address the inevitability of  human fallibility, the focus is placed on establishing systems that are designed to reduce and avoid error. Additionally, these systems also include the expectation of error and are built to catch mistakes and reduce the likelihood of injury and harm. Key components of human factors techniques include: briefings, sophisticated communication techniques, situational awareness, practice and recognition/addresses of vulnerabilities. These elements rely on solid teamwork and commitment from each member of the team.  
  Holy Cross Hospital's high-reliability Perinatal safety project is based on "safety first" for the patients, physicians, and other staff within our high volume Perinatal service . To create the culture of safety, a multidisciplinary team--including representatives from nursing, obstetrics, anesthesia, perinatology and neonatology-- was formed. The team's first action was to implement the use of SBAR (a structured communication format and acronym that stands for Situation, Background, Assessment, and Recommendation). All staff were trained in the use of these techniques towards the shared goal of clearly, accurately, and concisely communicating patient information, especially during an emergency. A critical component of this safety project  was the development and implementation of Critical Events Team Training (CETT). CETT uses scenario based simulation practice, briefings/debriefings, and structured communication strategies to foster multidisciplinary team work and superior communication in the high-risk Perinatal setting.  These simulations include participants who function in their roles and manage the situation as they would if it were real. Each CETT drill is a mini PDCA cycle: we plan the drill, we run the drill, we assess the drill, and then we act on this knowledge with our next drill. The success of this simulated practice is measured through the use of pre and post testing of participants. The questions are related to the perception of training participants relevant to the environment of safety within the unit as well as their self-assessment of readiness to respond to emergencies.