Is in situ simulation in emergency medicine safe? A scoping review

Abstract

ObjectivesTo provide an overview of the available evidence regarding the safety of in situ simulation (ISS) in the emergency department (ED).DesignScoping review.MethodsOriginal articles published before March 2021 were included if they investigated the use of ISS in the field of emergency medicine.Information sourcesMEDLINE, EMBASE, Cochrane and Web of Science.ResultsA total of 4077 records were identified by our search strategy and 2476 abstracts were screened. One hundred and thirty full articles were reviewed and 81 full articles were included. Only 33 studies (40%) assessed safety-related issues, among which 11 chose a safety-related primary outcome. Latent safety threats (LSTs) assessment was conducted in 24 studies (30%) and the cancellation rate was described in 9 studies (11%). The possible negative impact of ISS on real ED patients was assessed in two studies (2.5%), through a questionnaire and not through patient outcomes.ConclusionMost studies use ISS for systems-based or education-based applications. Patient safety during ISS is often evaluated in the context of identifying or mitigating LSTs and rarely on the potential impact and risks to patients simultaneously receiving care in the ED. Our scoping review identified knowledge gaps related to the safe conduct of ISS in the ED, which may warrant further investigation.

Educational and Patient Care Impacts of In Situ Simulation in Healthcare

“…10 Finally, 3 additional reviews noted the efficacy of in situ simulation in identifying latent safety threats. 7,9,12 Our review further supports these observations using a search strategy with broader scope.…”

“…A further review noted in situ simulation's value as a means of establishing an authentic environment of care but highlighted a lack of data regarding cost and effects on the clinical environment of care 10 . Finally, 3 additional reviews noted the efficacy of in situ simulation in identifying latent safety threats 7,9,12 . Our review further supports these observations using a search strategy with broader scope.…”

“…Several reviews have summarized prior research on in situ simulation. [7][8][9][10][11][12][13] The majority affirm its usefulness for the detection of latent safety threats and note a limited, but evolving, body of evidence supporting its beneficial effects on both learner behaviors and patient outcomes when used for education. Many of these, however, were conducted several years ago and/or are limited in clinical scope, thus missing recent and potentially relevant studies.…”

“…Several reviews have summarized prior research on in situ simulation 7–13 . The majority affirm its usefulness for the detection of latent safety threats and note a limited, but evolving, body of evidence supporting its beneficial effects on both learner behaviors and patient outcomes when used for education.…”

Testing the validity of three acute care assessment tools for assessing residents’ performance during in situ simulation: the ACAT-SimSit study

“…The go/no-go criterion was determined to ensure the safety of in situ simulation sessions. They were related to the ED environment (overcrowding, heavy clinical load and equipment needs) or the ED staff (medical or nursing understaffing, unanticipated events/threats to psychological safety) [13]. Two simulation types were used: hybrid (with simulated patients and a task trainer) and all-synthetic (with a low-fidelity mannikin).…”