PEARLS for Systems Integration

Abstract

Summary Statement Modern healthcare organizations strive for continuous improvement in systems and processes to ensure safe, effective, and cost-conscious patient care. However, systems failures and inefficiencies lurk in every organization, often emerging only after patients have experienced harm or delays. Simulation and debriefing, focused on identifying systems gaps, can proactively lead to improvements in safety and quality. Systems-focused debriefing requires a different approach than traditional, learner-focused debriefing. We describe PEARLS for Systems Integration, a conceptual framework, debriefing structure and script that facilitators can use for systems-focused debriefing. The framework builds on Promoting Excellence And Reflective Learning in Simulation, using common debriefing strategies (plus/delta, focused facilitation, and directive feedback) in a modified format, with new debriefing scripts. Promoting Excellence And Reflective Learning in Simulation for System Integration offers a structured framework, adaptable for debriefing systems-focused simulations, to identify systems issues and maximize improvements in patient safety and quality.

Use of Virtually Facilitated Simulation to Improve COVID-19 Preparedness in Rural and Remote Canada

“…Following the simulation, the participants engaged in a focused debrief using a PEARLS learner-focused approach and then used PEARLS for systems integration at the end of each debriefing to target specific systems pre-determined objectives. (Eppich & Cheng, 2015;Dubé et al, 2019b). This blended approach, which was used throughout the province for COVID-19 SBE (Dubé et al, 2020a), allowed the facilitators to identify debriefing topics while providing actionable steps for local implementation and improvement ( Table 2).…”

Recent Advances in Simulation for Pediatric Critical Care Medicine

“…A standardized scenario of pediatric anaphylaxis performed in 28 international hospitals identified a high medication error rate, and the postevent debriefings revealed a common LST across institutions related to decision support aids [51]. Learning opportunities from these system-focused simulations can be maximized by using a specific debriefing framework such as PEARLS for system integration [16] which is based on Systems Engineering Initiative for Patient Safety (SEIPS) 2.0, a human-factors model of patient safety and the healthcare system [93].…”

Rapid cycle system improvement for COVID-19 readiness: integrating deliberate practice, psychological safety and vicarious learning

“…Specifically, participants were asked to give feedback on the processes in infection control within the respective settings after the simulation that were enablers or barriers to patient and staff safety. 17 The pre-briefing script was also crafted to build psychological safety to enhance learning. 15 Prior to engaging in the simulation scenario, participants viewed two videos of teams conducting airway management for a confirmed patient with COVID-19-one with ideal performance and other with behaviours that could be improved.…”

“…35 To achieve goals of process testing and system integration, the participants were orientated at the beginning of the simulation to the system testing purposes of the simulation, and also be given the opportunity of expressing their thoughts and concerns about the processes in infection control within the respective settings. 17 Close collaboration and communication were maintained with the infection-control team, which was responsible for the development of guidelines and workflow processes for infection control within operating theatre and ICU. Results from system testing were documented and fed back to the infection-control team for modification of the workflow processes iteratively, and retested in the simulation setting until saturation was reached.…”