Enhancing Safety of a System-Wide In Situ Simulation Program Using No-Go Considerations.

Area of Science:

• Medical Simulation
• Obstetrics and Gynecology
• Emergency Medicine

Background:

• A large-scale in situ simulation initiative for cardiac arrest in pregnancy was conducted across NYC Health + Hospitals.
• In situ simulation requires balancing clinical demands with safety protocols, including "no-go" considerations to cancel or postpone sessions.
• The study aimed to report findings on the application of these no-go considerations during the initiative.

Purpose of the Study:

• To describe the application and impact of "no-go" considerations in a system-wide in situ simulation program for obstetric emergencies.
• To analyze the frequency and reasons for simulation cancellations or postponements.
• To provide a model for using no-go data to enhance safety and planning in future simulation endeavors.

Main Methods:

• An in situ simulation program focused on cardiac arrest in pregnancy was developed and implemented at 11 acute care facilities.
• The program utilized a toolkit of 13 established "no-go" considerations to ensure patient and staff safety.
• Data on the application of no-go considerations were collected from June 2018 to December 2019.

Main Results:

• Out of 274 scheduled simulations, 223 (81%) were completed, with 51 (19%) no-go events reported.
• Reasons for cancellation were categorized for 78% of no-go events, while 22% lacked reported reasons or categories.
• Four of the 13 suggested no-go considerations were not utilized during the initiative.

Conclusions:

• The "no-go" considerations framework facilitates standardized and strategic scheduling of in situ simulations.
• Analyzing the application of no-go considerations offers a valuable model for enhancing safety and informing future simulation planning.
• This approach supports continuous improvement in high-stakes medical simulation training.