Fast efficient teamwork is critical if an open heart surgery patient goes into cardiac arrest and a Waikato simulation training programme is dedicated to training teams to do just that.
Waikato Hospital is the first in the country to provide Cardiac Surgery Advanced Life Support training – or CALS.
The course allows teams to practice and efficiently respond to a patient in cardiac arrest following heart surgery.
It was developed in the United Kingdom after nursing and junior medical staff said they felt disorganised and of little help and would have performed better if they had a defined and well-practised role.
Training focuses on teamwork and communication, with each member of the team assigned a role.
A sophisticated manikin that imitates a patient’s post-heart surgery body, including the internal structures covered by the sternum and held together with sternal wires is used during the training.
Waikato Hospital cardiothoracic surgeon and CALS NZ course director David McCormack said a tiny percentage of patients – about 1 to 3 per cent – had their heart stop after surgery.
“Before about 2004, the protocol for resuscitation internationally was not bespoke to heart surgery. Pumping up and down on their chest won’t pump blood to the brain after heart surgery if the cause is severe bleeding from, or around, the heart.”
McCormack said medical teams working together gave the patient the best chance of survival.
Critical care and theatre staff, heart surgeons, intensive care doctors, anaesthetists and cardiac ward nurses must all work “in sync” to get the best outcome for the patient.
“You’ve got five minutes to get it sorted. It’s all about teamwork. With CALS everyone has an assigned role, and everyone knows how to do that role.”
He said the training’s focus on teamwork and communication had had benefits for the entire practice.
“It’s changed the culture in the team. We all work together, and it has brought us together outside of the intensive care unit as well.”
International CALS director Adrian Levine said the training emphasised the teamwork approach at all times.
“The results of this have been not only more patients surviving after a cardiac arrest post cardiac surgery, but also greater satisfaction and confidence in the medical staff looking after such patients.”
Each team member had a number of simple tasks to carry out which, when done in a coordinated manner, resuscitated patients as quickly as possible, he said.
“The simplicity of the protocols and the easy way that they can be taught make these skills easy to pick up and retain.”
As well as the internationally endorsed CALS NZ courses, regular in-house training sessions have been developed by Waikato Hospital critical care nurse educators Mark Reynolds and Jackie Mailer.
Mailer said CALS helped bring medical teams together quickly.
“Staff are proactive rather than reactive which is crucial in a time critical situation.”
The allocated roles to each of the medical team were key, she said.
“The pre-allocated roles are pivotal. People know what they are doing, there’s no waiting for permission to do it. It’s given some autonomy to people.”
Waikato District Health Board is the only place in the country to provide CALS training.
McCormack said the board was working with teams across Australia, Europe and America to develop and deliver the course.
“As a result of our expertise and training resources, we have been awarded the international Centre of Excellence status and can share it with other hospitals in New Zealand.”
Levine said the status was given to a “select number” of hospitals around the world.
“It is a major achievement for any cardiac surgical centre and is a testament to the dedication and innovative ways of working pioneered by the staff at Waikato.”
To date Waikato DHB has run 10 internal courses and three national courses, including training staff from most of the cardiac surgery units in New Zealand.
Levine said he would encourage all medical professionals involved in the care of cardiac surgical patients to undertake the training.
“I think that the outstanding job that has been done by the Waikato group should encourage other units to send their staff to Waikato to be trained and then return to their units to spread the ‘CALS way’ across New Zealand.”
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