Journal of Surgical Simulation 2015; 2: A: 6 - 6
Published: 30 June 2015
Special Issue: In situ simulation programme at Homerton University Hospital: patient safety training for the high reliability organisation
Aims: To develop regular simulation training on the acute care unit (ACU) for the multidisciplinary medical emergency team.
Methods: All simulations were performed using the iSimulate ALSi (iSimulate, Australia), which acted as the patient monitor, and a Resusci Anne mannequin (Laerdal Medical, Norway). The on-call medical registrar was invited to participate with a nurse and junior doctor. Participants were briefed beforehand. Training was explained to patients in nearby bed spaces. Eight scenarios were developed based around clinical incidents and mapped to relevant curricular objectives. Sessions were kept short minimising the impact to the working day. Feedback using an anonymised paper-based questionnaire was collected from trainees and observing patients, the latter to better understand the public’s perception of this training.
Results: Between November 2013 and July 2014, 24 weekly in-situ simulation sessions were delivered on ACU. On two occasions there were no free beds or available staff to carry out the training. Sessions required at least one member of faculty to run the scenario and facilitate team debriefing. 63% of scenarios were led by the medical registrar. Nurses and foundation doctors were involved in all simulation sessions totalling 78 multidisciplinary training experiences. 100% of staff agreed the training was relevant to their practice and beneficial to train within their usual working environment. 100% valued the opportunity to learn within their multidisciplinary teams. Less than 10% thought the training had been disruptive to their work duties that day. Twenty-eight patients and their visitors provided feedback. Over 50% were already aware that healthcare professionals learnt using simulation. 100% were reassured knowing that the staff caring for them were undertaking this type of training. In-situ simulation identified clinical governance issues, gaps in knowledge and unavailable medications and equipment. These included a lack of awareness of trust policies e.g. a new major haemorrhage protocol, missing oxygen connectors and emergency drugs not available on the resuscitation trolley.
Conclusions: In-situ simulation is a feasible method to deliver regular training in a busy work environment. Patients are supportive of this type of teaching. Running sessions regularly allows scenarios to be tailored to provide responses to clinical incidents. New guidelines/policies can be incorporated to keep staff updated so important learning is disseminated. Delivering training within the workplace ensures that learning is transferable to the real world. It identifies latent errors in clinical environments preventing potential harm before it occurs. This reflects a development in patient safety culture whereby training is not just reactive but proactive.
In situ simulation; patient safety
This presentation was given at "Striving Towards the High Reliability Organisation", Fourth Annual Simulation Conference, Homerton University Hospital, London UK on 11 December 2014.