In situ simulation in emergency medicine: Moving beyond the simulation lab

Abstract

In situ simulation (ISS), a point of care training strategy that occurs within the patient care environment involving actual healthcare team members, provides additional benefits to centre-based simulation. ISS can serve several roles within emergency medicine (EM): improves provider/team performance, identifies and mitigates threats to patient safety and improves systems and infrastructure. The effective use of ISS fosters inter-professional team training and a culture of safety essential for high performance EM teams and resilient systems. Using a case example, this article addresses the uses of ISS in EM, strategies for implementation and mitigation strategies for ED-specific challenges.

Providers' Perceptions of Caring for Pediatric Patients in Community Hospital Emergency Departments: A Mixed‐methods Analysis

“…In‐situ simulations involve the presentation of a patient to an interdisciplinary team of frontline providers in their actual clinical work space using real equipment. These simulations can be used to train providers and teams (especially around low‐frequency, high‐stakes cases) and to probe systems for latent safety threats . Debriefings involve teams self‐reflecting on the simulation experience and provoke participants to express their cognitive and emotional frames .…”

In-situ simulation to ‘road test’ a new paediatric clinical decision unit: mitigating the risk from latent safety threats

“…ISS has a clear advantage over lab-based simulation in allowing LSTs to be identified as the scenarios take place in the actual working environment and therefore components of the system beyond the ‘people’ can be tested, as can the interactions between various components of a system 4. The simulation element of this project identified many LSTs, most of which were categorised into the ‘non-human’ domain of the SEIPS model.…”

“…Among these imperfections exist latent safety threats (LSTs), defined as ‘conditions or threats…where the damaging consequence may lie dormant for some time, only becoming evident when local triggering factors overcome the organisations’ defense’ 3. There is an increasing body of evidence supporting the use of in-situ simulation (ISS) to identify LSTs 2 4. In view of this, and the inherent risk of opening a new department, we designed a programme of ISS with the following aims:To identify and resolve specific staff concerns and knowledge gaps regarding the normal operating procedure of the PCDU.To identify LSTs arising from new systems and resolve them.To check that resolutions had been effective.…”

Simulation in Saudi Arabian nursing education: Implications for student learning and patient safety

“…*The history of simulation can be traced back to the advent of modern time, when it was utilized by the military, nuclear power and aviation industries. In the field of aviation, flight simulators are used for pilot training to provide real-life scenarios (McLean et al, 2016), while in medical practice, simulation is considered a cornerstone for students to enhance their skills in clinical areas (Petrosoniak et al, 2017). Simulation forms an integral component of education for future healthcare providers in terms of both medicine and nursing.…”