Synopsis
Tea trolley teaching is a novel training method, where a trolley loaded with tea, cakes and educational materials is taken to the place of work, providing short, 10 minute educational sessions at the times and in locations that suit learners. A small group of nursing and medical staff have established a regular program of tea trolley teaching sessions within our Intensive Care Units (ICU), improving the education and wellbeing of our staff, at negligible cost. This allows staff members from multiple disciplines to receive education on topics pertinent to the unit, whilst minimising the impact on patient care.
Ambition
Providing education within the ICU can be difficult, due to the varied nature of staff members shift patterns, with high intensity work but fluctuating workload levels. GMC survey feedback has consistently identified staff education as area of weakness within the ICU.
We hoped to establish a program that could teach on a range of topics to a broad number of staff within our units, at times and in locations which suited staff members. To achieve this, we utilised the method of teaching known as Tea Trolley Teaching, originally established in Bath, and drew on their experience to develop a program of our own.
Goals that we had for the program were to cover at least one topic per month, running multiple sessions over a number of days. This means that if staff members were busy with patient care or not working when one session was run, they would have other opportunities to participate. We believe we are the first Intensive Care Unit in the country to set up a formal, regular program of Tea Trolley Teaching such as this.
Broadly speaking, we aimed to have two main themes of topics - those considered essential core knowledge, and those considered currently topical, most likely because of recent clinical Incidents. Topics are chosen to be relevant to all members of the multidisciplinary team. Sessions were taught by staff from a range of professional backgrounds, with teaching programs established and run by not just doctors, but also physiotherapists and nurses. We will also soon have sessions run by dieticians.
To engage staff members, we focused on not just didactically providing content, but by using small group, interactive teaching - focusing on a number of 21st Century learning principles. We aimed to keep sessions short and directed, but to also inject a level of fun into the learning process, while keeping it highly relevant to the ICU. By providing tea and refreshments staff were also more engaged and able to have a break while taking part in the 10-minute education session.
Outcome
Since June 2019, we have provided almost 400 education episodes covering topics such as emergency management of the displaced tracheostomy, use of equipment such as the Arctic Sun for cooling of patients, as well as hand hygiene and positive patient identification.
In just the first month, we had 86 education episodes, covering most of the junior medical staff, and over half of the nursing staff employed by the unit. Since then, in response to staff feedback, we have expanded the program out to a second hospital site within the Trust and have increased the number of topics we cover a month.
After each educational session we collect feedback from those participating, to understand their overall feeling towards the lesson, as well as the effect that it has had on their confidence and understanding of the topic. We have been overwhelmed by the positive feedback that we have received, with staff reporting significant improvements in confidence, as well as providing many written responses of support and thanks.
Furthermore, staff have reported a beneficial effect on their work. For example, since the first session on tracheostomy management, we have had a displaced tracheostomy occur within the unit. Staff completing a follow up survey reported that the training they had received through tea trolley teaching provided a significant benefit to their management of the situation.
Not only has participant feedback been highly positive, but we have also had many staff members approach us with topics they would like to deliver within our program. As such, we have had sessions taught by a range of team members. We are currently running sessions on chest drain management run by respiratory trainees who are on rotation to ICU. Nursing staff have led highly successful sessions of the Arctic Sun and patient cooling, and the physiotherapy team have run very popular sessions on ASIA scoring for spinal cord injury patients. We also look forward to future sessions, with one next month being run by the dietician team.
Spread
After the completion of each topic we provide a summary of the feedback to staff members within the unit. We have also shared our results more widely across the Health Service, both locally and internationally. We have provided support and publicity for our Hospital charity and use Twitter to try and reach health workers further afield. We have presented our program at multiple local and international conferences, including the Association for Simulated Practice in Healthcare, as well as the World Airway Management Meeting.
As we have shared our results, and staff have seen the success of the program, other departments have approached us to help them with developing a similar programme. We have so far collaborated to introduce Tea Trolley Teaching within the large theatre complex, to the Head and Neck ward, to the resuscitation department across the whole hospital, and to the ICU of a neighbouring hospital. As a relatively recently established project. Tea Trolley teaching sessions planned for these areas are being implemented in the coming months, with a neighbouring ICU piloting sessions in mid-December 2019, and other areas within our hospital happening in January and February 2020.
Value
Tea Trolley Teaching is a very low-cost project. The tea trolley itself cost £40 that, together with an airway manikin, was provided by our Hospital charity grant. Staff who deliver the teaching are either already rostered to be on non-clinical days or fit it in amongst their other commitments. For staff being taught, this is done at the bedside; fitting in around their existing work. We are meticulous to ensure that the training does not take staff away from patient care, and we believe we are the first Tea Trolley Teaching team to have collected patient and family feedback, to ascertain their perception of the programme.
In contrast to traditional ways of training staff, there is no cost at all from taking these staff off the ICU, as the training is provided during their working shift, in the workplace. Staff also do not need to come in on their days off to receive this training. In contrast with more intensive teaching methods, such as simulation or standalone training days. Tea Trolley Teaching is significantly cheaper, and allows a much broader reach with a lower resource usage.
The staff delivering teaching tend to supply cakes or cookies, with many becoming highly creative in bringing snacks which relate to their teaching topic. Basic snacks are also provided by the Tea Trolley Team.
This is a highly interactive teaching method, fun to deliver and receive - and therefore very memorable - and is in keeping with principles of modern pedagogy. Staff thoroughly enjoy this training and regularly request more sessions and topics.
Involvement
When establishing this training program, and with all new topics covered, we sought input from a variety of sources within and outside our ICU. By discussing with the education team of all staff groups within the unit, we were able to ascertain topics which would be of interest to all professional groups, both to be taught, but also which areas they would be interested in teaching.
We also sought input from other teams within our ICU, for example, the clinical governance team, who suggested hand hygiene and positive patient identification as important areas to cover with our teaching.
We have a strong ongoing relationship with Oxford Hospitals Charity who have supported us by providing funding for equipment. Together we have completed a recent photoshoot to publicise the benefit they have provided to our unit as well as our teaching programme.
We have also reached out to other hospital networks both at conferences and through social media. These are groups who have established tea trolley teaching in their units or hope to. This has allowed us to share ideas, help solve problems and encourage others in the development of their own programs.
We have sought feedback from patients and staff in the form of informal surveys, however, are aiming to formalise this by establishing an independent assessment by an external clinician to assess the impacts of our training on patients and their families. We believe this is the first time in this country that patient and relative feedback has been collected during Tea Trolley teaching sessions for staff.
Leaders within our unit have expressed thanks and encouragement of our work.
“Many thanks for your ongoing work with this, 86 staff members (and counting!) Is very impressive in the time that it has been running. Well done!” - Dave Garry, Clinical Lead
“This is a great achievement. What a success - long may it continue, Thank you” - Lyn Bennett, Matron
“I have only heard positive feedback regarding your tea trolley teaching. Many staff have said it’s a really fun and clear, and have found it really useful!” – Olivia Johnson, Clinical Governance Coordinator.
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