The effects of interactive training of healthcare providers on the management of life-threatening emergencies in hospital

What is the aim of this review?

We aimed to find out if healthcare workers who work in hospitals and receive training where they can interact with learning materials and other workers give better healthcare during emergency situations.

Key messages

We are unsure about if interactive training for emergency situations improves healthcare, as there were conflicting results between studies and problems with the methods the trials used which could lead to false results.

What was studied in this review?

Hospital-based healthcare workers need to be well prepared to react expertly to emergency situations that threaten people's lives. There are many training courses for this, some of which allow healthcare workers to interact with learning materials and other workers. However, we do not know if these training courses prepare healthcare workers to provide better healthcare.

We searched for studies that assessed the effectiveness of interactive training compared to usual training or no training. We looked only at the type of study thought to be the strongest form of evidence, that is randomised trials (where participants could be assigned to either the training group or no/standard-training group by chance). We looked for any effects on patient outcomes (e.g. survival or length of hospital stay), any effects on staff (e.g. improved skills in an actual clinical situation), or changes within the organisation (e.g. reorganisation of working patterns). We did not look at changes in a simulated environment.

What are the main results of this review?

We found 11 studies that were relevant to this review. Nine of these focused on maternal and newborn health. Because there were so few studies and they all examined different effects of emergency training, we were unable to combine the results.

All of the trials included weaknesses in their design that could have lead to inaccurate results. The certainty of evidence for our important outcomes focusing on changes to patient care/outcomes was very low, therefore based on the available evidence we are uncertain as to whether training of healthcare workers in the management of life-threatening emergency situations made a difference to patients or organisations. The studies were paid by government, local hospitals, or charities.

How up-to-date is this review?

We looked at all of the studies examining this area up until March 2019.

Authors' conclusions: 

We are uncertain if there are any benefits of interactive training of healthcare providers on the management of life-threatening emergencies in hospital as the certainty of the evidence is very low. We were unable to identify any factors that may have allowed us to identify an essential element of these interactive training courses.

We found a lack of consistent reporting, which contributed to the inability to meta-analyse across specialities. More trials are required to build the evidence base for the optimum way to prepare healthcare providers for rare life-threatening emergency events. These trials need to be conducted with attention to outcomes important to patients, healthcare providers, and policymakers. It is vitally important to develop high-quality studies adequately powered and with attention to minimising the risk of bias.

Read the full abstract...
Background: 

Preparing healthcare providers to manage relatively rare life-threatening emergency situations effectively is a challenge. Training sessions enable staff to rehearse for these events and are recommended by several reports and guidelines. In this review we have focused on interactive training, this includes any element where the training is not solely didactic but provides opportunity for discussions, rehearsals, or interaction with faculty or technology. It is important to understand the effective methods and essential elements for successful emergency training so that resources can be appropriately targeted to improve outcomes.

Objectives: 

To assess the effects of interactive training of healthcare providers on the management of life-threatening emergencies in hospital on patient outcomes, clinical care practices, or organisational practices, and to identify essential components of effective interactive emergency training programmes.

Search strategy: 

We searched CENTRAL, MEDLINE, Embase, CINAHL and ERIC and two trials registers up to 11 March 2019. We searched references of included studies, conference proceedings, and contacted study authors.

Selection criteria: 

We included randomised trials and cluster‐randomised trials comparing interactive training for emergency situations with standard/no training. We defined emergency situations as those in which immediate lifesaving action is required, for example cardiac arrests and major haemorrhage. We included all studies where healthcare workers involved in providing direct clinical care were participants. We excluded studies outside of a hospital setting or where the intervention was not targeted at practicing healthcare workers. We included trials irrespective of publication status, date, and language.

Data collection and analysis: 

We used standard methodological procedures expected by Cochrane and Cochrane Effective Practice and Organisation of Care (EPOC) Group. Two review authors independently extracted data and assessed the risk of bias of each included trial. Due to the small number of studies and the heterogeneity in outcome measures, we were unable to perform the planned meta-analysis. We provide a structured synthesis for the following outcomes: survival to hospital discharge, morbidity rate, protocol or guideline adherence, patient outcomes, clinical practice outcomes, and organisation-of-care outcomes. We used the GRADE approach to rate the certainty of the evidence and the strength of recommendations for each outcome.

Main results: 

We included 11 studies that reported on 2000 healthcare providers and over 300,000 patients; one study did not report the number of participants. Seven were cluster randomised trials and four were single centre studies. Four studies focused on obstetric training, three on obstetric and neonatal care, two on neonatal training, one on trauma and one on general resuscitations. The studies were spread across high-, middle- and low-income settings.

Interactive training may make little or no difference in survival to hospital discharge for patients requiring resuscitation (1 study; 30 participants; 98 events; low-certainty evidence). We are uncertain if emergency training changes morbidity rate, as the certainty of the evidence is very low (3 studies; 1778 participants; 57,193 patients, when reported). We are uncertain if training alters healthcare providers' adherence to clinical protocols or guidelines, as the certainty of the evidence is very low (3 studies; 156 participants; 558 patients). We are uncertain if there were improvements in patient outcomes following interactive training for emergency situations, as we assessed the evidence as very low-certainty (5 studies, 951 participants; 314,055 patients). We are uncertain if training for emergency situations improves clinical practice outcomes as the certainty of the evidence is very low (4 studies; 1417 participants; 28,676 patients, when reported). Two studies reported organisation-of-care outcomes, we are uncertain if interactive emergency training has any effect on this outcome as the certainty of the evidence is very low (634 participants; 179,400 patient population).

We examined prespecified subgroups and found no clear commonalities in effect of multidisciplinary training, location of training, duration of the course, or duration of follow-up. We also examined areas arising from the studies including focus of training, proportion of staff trained, leadership of intervention, and incentive/trigger to participate, and again identified no clear mediating factors. The sources of funding for the studies were governmental, local organisations, or philanthropic donors.

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