Educational and Research Implications of Portable Human Patient Simulation in Acute Care Medicine

Kobayashi, Leo; Patterson, MEd Mary D.; Overly, Frank; Shapiro, Marc J.; Williams, Kenneth; Jay, Gregory D.

doi:10.1111/j.1553-2712.2008.00179.x

Cited by 42 publications

(29 citation statements)

References 50 publications

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“…The obvious benefits, as demonstrated in our results and those of Lighthall et al ,14 are the benefits of delivering training directly to the entire multidisciplinary team in a low-risk, believable environment that is relevant to them,17 and preventing the need to provide ‘relief’ for a preplanned training session. The time spent giving structured feedback is as valuable as the simulation itself because it is rare for team members participating in a ‘real’ cardiac arrest to spend time debriefing due to the pressures of clinical work, a finding that was similarly reported by Miller et al 18.…”

Section: Discussionsupporting

confidence: 55%

Unannounced in situ simulations: integrating training and clinical practice

et al. 2012

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Simulation-based training for healthcare providers is well established as a viable, efficacious training tool, particularly for the training of non-technical team-working skills. These skills are known to be critical to effective teamwork, and important in the prevention of error and adverse events in hospitals. However, simulation suites are costly to develop and releasing staff to attend training is often difficult. These factors may restrict access to simulation training. We discuss our experiences of 'in situ' simulation for unannounced cardiac arrest training when the training is taken to the clinical environment. This has the benefit of decreasing required resources, increasing realism and affordability, and widening multidisciplinary team participation, thus enabling assessment and training of non-technical team-working skills in real clinical teams. While there are practical considerations of delivering training in the clinical environment, we feel there are many potential benefits compared with other forms of simulation training. We are able to tailor the training to the needs of the location, enabling staff to see a scenario that is relevant to their practice. This is particularly useful for staff who have less exposure to cardiac arrest events, such as radiology staff. We also describe the important benefit of risk assessment for a clinical environment. During our simulations we have identified a number of issues that, had they occurred during a real resuscitation attempt, may have led to patient harm or patient death. For these reasons we feel in situ simulation should be considered by every hospital as part of a patient safety initiative.

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Section: Discussionsupporting

confidence: 55%

Unannounced in situ simulations: integrating training and clinical practice

et al. 2012

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“…In situ simulation has become more common particularly in its use to evaluate new facilities and systems 5 24–26. Especially related to critical conditions in obstetrics and cardiopulmonary arrest, there are deliberate efforts to use in situ simulation to detect LSTs 27 28.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2012

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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.

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“…In situ simulation offers a unique form of experiential learning that has been effectively used in the labour/delivery room,6 OR suite,8 14 34 ED,16 trauma resuscitation room,7 13 17 35 PICU36 and hospital inpatient ward 9 11 12 15 37–39. In the current series, we report our experience with the use of in situ simulation to identify and resolve latent safety threats and improve the quality of care delivered to children suffering a cardiopulmonary arrest.…”

Section: Discussionmentioning

confidence: 99%