In situ simulation and its effects on patient outcomes: a systematic review

Abstract

BackgroundThe use of in situ simulation has previously been shown to increase confidence, teamwork and practical skills of trained professionals. However, a direct benefit to patient outcomes has not been sufficiently explored. This review focuses on the effect of in situ simulation training in a hospital setting on morbidity or mortality.MethodsA combined search was conducted in PUBMED, OVID, WEB OF SCIENCE, CINAHL, SCOPUS and EMBASE. 478 studies were screened with nine articles published between 2011 and 2017 meeting the inclusion criteria for analysis.ResultsThis review selected eight prospective studies and one prospective-retrospective study. Three studies isolated in situ simulation as an experimental variable while the remaining studies implemented in situ programmes as a component of larger quality improvement initiatives. Seven studies demonstrated a significant improvement in morbidity and/or mortality outcomes following integrated in situ simulation training.ConclusionExisting literature, albeit limited, demonstrates that in situ training improves patient outcomes either in isolation or within a larger quality improvement programme. However, existing evidence contains difficulties such as isolating the impact of in situ training from various potential confounding factors and potential for publication bias.

Virtual application of in situ simulation during a pandemic

“…BACKGROUND Previous work has demonstrated the utility of in situ simulation to advance health care provider skills and aid in the development of protocols and procedures. 1,2 However, the use of simulation under the constraints inflicted by a pandemic has not yet been addressed. The coronavirus disease 2019 (COVID-19) pandemic posed new challenges to the execution of in situ simulation in the emergency department (ED), as well as timesensitive pressures for the development of protected code blue and intubation protocols.…”

Connecting simulation and quality improvement: how can healthcare simulation really improve patient care?

“…Location is also relevant, as 'in situ simulation'-"taking place in the actual patient care setting/environment" 9 -affords a closer connexion to the physical environment for 'real', often ad hoc teams, to identify enablers or barriers for QI interventions. 10 However, the effect could also lie in simulation shaping the culture and relationships 11 12 that underpin and support structural or process specific interventions.…”

“…Numerous case study examples of using simulation to improve patient care are now being synthesised in systematic reviews, 10 yielding practical guidelines for using in situ simulation in QI, and building conceptual frameworks for how impacts are achieved. Sollid et al reported on a consensus process "to define priorities in healthcare simulation that contribute the most to improve patient safety", 24 which included two of the five identified priorities clearly at the interface with QI: effectiveness and system probing.…”

Using a bespoke database to manage latent safety threats identified through in situ simulation

“…The difficulty of demonstrating changes in an outcome measure is highlighted by the rarity of studies demonstrating improvement in outcomes related to simulation. 4…”