In situ simulation: Taking reported critical incidents and adverse events back to the clinic

Research output: Contribution to conferencePosterResearchpeer-review

In situ simulation offers a novel approach to training in the healthcare setting. It models clinical processes in a real clinical environment and provides the opportunity to correct errors and adjust team interactions without endangering patients. Training in the simulation laboratory does not tap into situational resources, e.g. individual, team, and organisational characteristics such as routines, personal relations, distributed skill-levels etc. Therefore, it fails to fully mimic real clinical team processes. Alternatively, in situ simulation offers a unique opportunity to explore and improve team processes in the clinical environment. Though research on in situ simulation in healthcare is in its infancy, literature is abundant on patient safety, medical simulation, team training and human factors1. Patient safety reporting systems that identify risks to patients can improve patient safety if coupled with training and organisational support2. Insight into the nature of reported critical incidents and adverse events can be used in writing in situ simulation scenarios and thus lead to interventions that enhance patient safety. The patient safety literature emphasises well-developed non-technical skills in preventing medical errors3. Furthermore, critical incidents and adverse events reporting systems comprise a knowledgebase to gain in-depth insights into patient safety issues. This study explores the use of critical incidents and adverse events reports to inform in situ simulation to improve patient safety.

Design and purpose
The study uses a case study design of in situ simulation training tailored to two emergency departments in the Central Denmark Region. We aim to:

- Develop a model that integrates critical incidents and adverse events, a contextual needs analysis and short-term observations in the design of in situ simulation.
- Deliver and evaluate the usability of in situ simulation training to interprofessional emergency teams.

The project has a triple strategy: 1) Patient safety data analysis and literature review, 2) Video observational study on interprofessional emergency teams, and 3) In situ simulation intervention study with evaluation of training.

Reported critical incidents and adverse events will be collected from the Danish Patient Safety Database in the Central Denmark Region and analysed using the qualitative software programme NVivo 10 for content analysis4 and thematic analysis5. Medical experts and simulation faculty will design scenarios for in situ simulation training based on the analysis. Short-term observations using time logs will be performed along with interviews with key informants at the departments. Video data will be collected and used for debriefing6 focusing on team communication and team adaptation7 after in situ simulation training.

Perspective and relevance
First, this study might help taking reported critical incidents and adverse events back to the clinic. Second, reported critical incidents and adverse events coupled with a contextual needs analysis and short-term observations might aid in scenario design for in situ simulation. This will shed light on how to develop specific learning goals for in situ simulation based on clinical challenges in acute healthcare settings. Third, in situ simulation offers a unique way to study team interactions associated with effective interprofessional teamwork. In particular, team non-technical skills and team adaptation, and their interplay will be scrutinised. In summary, this study offers in situ simulation faculty with a model for integrating reported critical incidents and adverse events with contextual needs analysis and short-term observations. This study generates system knowledge that might lead to changes on the individual, team, and organisational level, and thus enhancing patient safety.

(1) Rosen MA, Hunt EA, Pronovost PJ, Federowicz MA, Weaver SJ. In situ simulation in continuing medical education for the health care professions: A systematic review. J Contin Educ Health Prof 2012; 32(4):243-254.
(2) Flin R, O'Connor P, Crichton M. Safety at the sharp end. A guide to non-technical skills. England: Ashgate Publishing Ltd.; 2008.
(3) Manser T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol Scand 2009; 53(2):143-151.
(4) Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nursing 2008; 68:62-107.
(5) Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3:77-101.
(6) Mackenzie CF, Xiao Y. Video techniques and data compared with observation in emergency trauma care. Qual Saf Health Care 2003; 12 Suppl 2:ii51-ii57.
(7) Bedwell WL, Ramsay S, Salas E. Helping fluid teams work: A research agenda for effective team adaptation in healthcare. TBM 2012; 2:504-509.

Original languageEnglish
Publication year2014
Number of pages2
Publication statusPublished - 2014

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