Unannounced in situ simulations: integrating training and clinical practice

Abstract

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.

Unannounced in situ simulation of obstetric emergencies: staff perceptions and organisational impact

“…An advantage of ISS is that it is conducted in the real workplace, thus making it possible to train staff and also identify systemic weaknesses, which in turn forms the basis for required organisational changes 15–18. Some have argued that ISS is more feasible and cost saving compared with traditional simulation conducted in simulation centres 19 20. Some studies concluded that ISS is met with widespread acceptance among participants and has resulted in a collaborative approach to patient safety 14 19 21 22…”

In Situ Simulation Training for Neonatal Resuscitation: An RCT

“…3 The results of this CEP led us to believe that overall performance of the staff could be improved if staff members were trained in situ and over a short period because each member would acquire the same background and follow the same algorithm. Although several studies have shown that in situ simulation training improves the individual skills of professionals 4,5 and the quality of care, [6][7][8][9][10] to our knowledge, there are no data regarding the impact of in situ training on global performance in neonatal resuscitation .…”

In situ simulation as a quality improvement initiative:

“…As InST happens in actual clinical environments, approval of the senior clinical and management teams in paediatric A&E and NNU was obtained by presenting the evidence supporting the role of InST in detecting LSTs1 2 and improving multidisciplinary team working 1–3. The local National Health Service trust's postgraduate education department fully supported the simulation training programme.…”