In situ simulation: detection of safety threats and teamwork training in a high risk emergency department

Abstract

Objective Implement and demonstrate feasibility of in situ simulations to identify latent safety threats (LSTs) at a higher rate than labbased training, and reinforce teamwork training in a paediatric emergency department (ED). Methods Multidisciplinary healthcare providers responded to critical simulated patients in an urban ED during all shifts. Unannounced in situ simulations were limited to 10 min of simulation and 10 min of debriefing, and were video recorded. A standardised debriefing template was used to assess LSTs. The primary outcome measure was the number and type of LSTs identified during the simulations. Secondary measures included: participants' assessment of impact on patient care and value to participants. Blinded video review using a modified Anaesthetists Non-Technical Skills scale was used to assess team behaviours. Results 218 healthcare providers responded to 90 in situ simulations conducted over 1 year. A total of 73 LSTs were identified; a rate of one every 1.2 simulations performed. In situ simulations were cancelled at a rate of 28% initially, but the cancellation rate decreased as training matured. Examples of threats identified include malfunctioning equipment and knowledge gaps concerning role responsibilities. 78% of participants rated the simulations as extremely valuable or valuable, while only 5% rated the simulation as having little or no value. Of those responding to a postsimulation survey, 77% reported little or no clinical impact. Video recordings did not indicate changes in nontechnical skills during this time.Conclusions In situ simulation is a practical method for the detection of LSTs and to reinforce team training behaviours. Embedding in situ simulation as a routine expectation positively affected operations and the safety climate in a high risk clinical setting.

In Situ Simulation Training for Neonatal Resuscitation: An RCT

“…7,13-15 A randomized controlled study in the Netherlands demonstrated an improvement in team performance in obstetrical management after training in a simulation center. 16 In situ simulation allows a better identification of systems issues 8,9 or safety threats 10,17 and has been shown to improve the management of deteriorating patients. 18 In situ training is less developed than training in a simulation center probably because it is more difficult to organize particularly when…”

“…10 In situ training and evaluation was feasible in our network because the simulator and all the equipment could be transported in a regular car; moreover, all the maternities were located ,200 km from the organizing center. We could not evaluate whether such a program including almost all the staff members and performed in a simulation center over a short period would have produced the same results.…”

“…3 The results of this CEP led us to believe that overall performance of the staff could be improved if staff members were trained in situ and over a short period because each member would acquire the same background and follow the same algorithm. Although several studies have shown that in situ simulation training improves the individual skills of professionals 4,5 and the quality of care, [6][7][8][9][10] to our knowledge, there are no data regarding the impact of in situ training on global performance in neonatal resuscitation .…”

The Impact of Rudeness on Medical Team Performance: A Randomized Trial

“…Moreover, simulations are becoming more widespread in medicine as an investigative tool. 44,45 Second, because the study was conducted in only 4 hospitals in 1 country, further research is required to assess the broad-scale generalizability of our findings. Third, despite evidence that the impact of rudeness is not conditioned according to source, 20,21 our findings may not be generalizable to rudeness stemming from other, nonauthority sources.…”

Intensive Care Society State of the Art 2017 Abstracts

“…All participants were asked to complete a human factors questionnaire after each session. Facilitators then completed a latent threats review which covered the crisis resource management issues below: (Patterson et al, 2013). Simulation also offers the opportunity to formally debrief the members of the multiprofessional team, something that occurs rarely in practice, and has been shown to be the most important element in providing effective learning in simulation-based education.…”