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Using In Situ Simulations to Improve Pediatric Patient Safety in Emergency Departments
Moon O Lee1, Kimberly Schertzer2, Kajal Khanna3
1M.O. Lee is associate professor, Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California.
Insights
In situ simulation training in emergency departments (EDs) improved pediatric readiness and identified safety threats. This approach enhances healthcare teams
Area of Science:
- Medical Education
- Patient Safety
- Emergency Medicine
Background:
- Patient safety events with serious consequences often occur in high-risk clinical settings like emergency departments (EDs).
- Low-frequency, high-risk events, such as pediatric resuscitations, offer limited opportunities for healthcare teams to practice and identify deficiencies in real-time.
- Lack of safe practice environments risks unprepared healthcare teams and suboptimal patient care.
Purpose of the Study:
- To evaluate the effectiveness of an in situ simulation program for pediatric resuscitation in non-academic EDs.
- To assess the impact of simulation training on clinical performance, teamwork, communication, and pediatric readiness.
Main Methods:
- A case series design using a train-the-trainer model for in situ simulation was employed.
- Healthcare professionals in 3 EDs were trained to conduct pediatric resuscitation in situ simulations.
- Teams (physicians, nurses, technicians) participated in simulations at baseline, 6, and 12 months, with subsequent debriefings and pediatric readiness assessments.
Main Results:
- In situ simulations identified previously unknown latent safety threats within the EDs.
- Team performance, teamwork, and communication were evaluated throughout the study period.
- Pediatric readiness scores were assessed at baseline and 12 months, indicating program impact.
Conclusions:
- In situ simulation is a viable method for improving pediatric readiness in EDs.
- The program facilitated the identification of critical safety hazards and enhanced team performance.
- Further research will explore the program's sustainability and potential translation to other clinical settings.
Problem:
Given the complex interaction among patients, individual providers, health care teams, and the clinical environment, patient safety events with serious consequences are most likely to occur in intensive care units, operating rooms, and emergency departments (EDs). With low-frequency, high-risk events such as pediatric resuscitations, health care teams working in EDs may not have the clinical opportunity to identify deficiencies, review and reinforce knowledge and skills, and problem solve in authentic clinical conditions. Without creating opportunities to safely practice, hospitals run the risk of having health care teams and environments that are not prepared to provide optimal patient care.
Approach:
Researchers employed a case series design and used a train-the-trainer model for in situ simulation. They trained health care professionals (instructors) in 3 general, nonacademic EDs in the San Francisco Bay area of California to perform pediatric resuscitation in situ simulations in 2018-2019. In situ simulations occur in the clinical work environment with simulation participants (teams) who are health care professionals taking care of actual patients.
Outcomes:
Teams made up of physicians, nurses, and ED technicians were evaluated for clinical performance, teamwork, and communication during in situ simulations conducted by instructors at baseline, 6 months, and 12 months. Debriefing after the simulations identified multiple latent safety threats (i.e., unidentified potential safety hazards) that were previously unknown. Each ED's pediatric readiness-its ability to provide emergency care for children-was evaluated at baseline and 12 months.
Next Steps:
The authors will continue to monitor and examine the impact and sustainability of the pediatric in situ simulation program on pediatric readiness scores and its possible translation to other high-risk clinical settings, as well as explore the relationship between in situ simulations and patient outcomes.
