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High-reliability emergency response teams in the hospital: improving quality and safety using in situ simulation training
  1. Derek S Wheeler1,2,3,
  2. Gary Geis2,4,5,
  3. Elizabeth H Mack6,
  4. Tom LeMaster5,
  5. Mary D Patterson7,8
  1. 1Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  2. 2Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
  3. 3The James M. Anderson Center for Health Systems Excellence, Cincinnati, Ohio, USA
  4. 4Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  5. 5The Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  6. 6Division of Critical Care Medicine, Palmetto Health Children's Hospital, Columbia, South Carolina, USA
  7. 7Division of Emergency Medicine, Akron Children's Hospital, Akron, Ohio, USA
  8. 8Simulation Center for Safety and Reliability, Akron Children's Hospital, Akron, Ohio, USA
  1. Correspondence to Derek S Wheeler, Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA; derek.wheeler{at}cchmc.org

Abstract

Introduction In situ simulation training is a team-based training technique conducted on actual patient care units using equipment and resources from that unit, and involving actual members of the healthcare team. We describe our experience with in situ simulation training in a major children's medical centre.

Materials and methods In situ simulations were conducted using standardised scenarios approximately twice per month on inpatient hospital units on a rotating basis. Simulations were scheduled so that each unit participated in at least two in situ simulations per year. Simulations were conducted on a revolving schedule alternating on the day and night shifts and were unannounced. Scenarios were preselected to maximise the educational experience, and frequently involved clinical deterioration to cardiopulmonary arrest.

Results We performed 64 of the scheduled 112 (57%) in situ simulations on all shifts and all units over 21 months. We identified 134 latent safety threats and knowledge gaps during these in situ simulations, which we categorised as medication, equipment, and/or resource/system threats. Identification of these errors resulted in modification of systems to reduce the risk of error. In situ simulations also provided a method to reinforce teamwork behaviours, such as the use of assertive statements, role clarity, performance of frequent updating, development of a shared mental model, performance of independent double checks of high-risk medicines, and overcoming authority gradients between team members. Participants stated that the training programme was effective and did not disrupt patient care.

Conclusions In situ simulations can identify latent safety threats, identify knowledge gaps, and reinforce teamwork behaviours when used as part of an organisation-wide safety programme.

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