[Innovation in healthcare processes and patient safety using clinical simulation]

Patient safety, what does clinical simulation and teaching innovation contribute?

Clinical simulation in Intensive Care Medicine is a crucial tool to strengthen patient safety. It focuses on the complexity of the Intensive Care Unit, where challenging clinical situations require rapid decision making and the use of invasive techniques that can increase the risk of errors and compromise safety. Clinical simulation, by mimicking clinical contexts, is presented as essential for developing technical and non-technical skills and enhancing teamwork in a safe environment, without harm to the patient. in situ simulation is a valuable approach to practice in realistic environments and to address latent security threats. Other simulation methods as virtual reality and tele-simulation are gaining more and more acceptance. Herein, we provide current data on the clinical utility of clinical simulation related to improved safety in the practice of techniques and procedures, as well as improvements of teamwork performance and outcomes. Finally, we propose the needs for future research.

Expanding scope of Kirkpatrick model from training effectiveness review to evidence-informed prioritization management for cricothyroidotomy simulation

Modified Kirkpatrick model has been adopted to evaluate training effectiveness by 6 categories, including activity accounting (training objectives/success in organization change) at Level-0, reaction (satisfaction) at Level-1, learning (acquisition of surgical airway skills) at Level-2, behavior (post-training change in personal strengths) at Level-3, result (organizational or clinical outcomes) at Level-4, and Return on Investment (ROI) or Expectation (ROE) (monetary and societal values following training and other quality and safety related measures) at Level-5. The purpose of this hospital-based prospective observational study was twofold: i) To evaluate potential impacts on monetary and societal values and successful organization change following implementation of advanced Cricothyroidotomy simulator and standardized curriculum in healthcare simulation training, ii) To inform decisions of resource allocation by reviewing overall values and prioritization strategies for i) general surgeon/emergency physician ii) with seniority >5 years and iii) prior porcine training experience based on findings at Kirkpatrick Level-0, Level-4, and Level-5. Seventy doctors and 10 nurses completed Cricothyroidotomy training and follow-up questionnaires within 2021/22. All training usability scoring measured by Scales of Emergency Surgical Airway Simulator (SESAS-17) achieved over 4 out of 5 (Level-4) with effects in favor of emergency physicians or general surgeons (p < .5), regardless of seniority and prior training experience. Success in organization change (Level-0) and cost-effectiveness (Level-5) were hypothetically established using theoretical framework of Gleicher's formula and Roger's Diffusion of Innovation Theory. Overall training effectiveness, in terms of advantage in usability, cost-benefits and successful organizational changes, provided sound evidence to support continuous investment of new curriculum and innovative simulator and "Surgeon-and-emergency-physician-first" policy when it comes to resources allocation strategies for Cricothyroidotomy training. [ACGME competencies: Practice Based Learning and Improvement, Systems Based Practice.].

Psychometric properties of the Spanish version of a questionnaire to evaluate clinical simulation in Health Sciences degrees

OBJECTIVE

To determine the psychometric properties of the Spanish version of the Jeffries questionnaire to assess perception, satisfaction and learning results in Clinical Simulation (QJSC) for students of Health Science degrees.

METHOD

For the transcultural adaptation to the Spanish language of the QJSC questionnaire, the inverse method was applied with a back translation. Internal consistency analysis was performed to assess reliability, analysed with Cronbach's alpha, a value between 0.90 and 0.95 was considered acceptable. To establish the content validity, a factor analysis was performed, only items with factor saturations greater than 0.60 were considered for interpretation. Statistical analyses were performed with the SPSS 19 programme. The administration of the questionnaire was carried out in 10-12 clinical simulation training sessions according to the subject programme with 10-12 students per session, for high-fidelity clinical simulation between 2017 and 2018, in a sample of 443 undergraduate students of the Health Sciences degrees corresponding to Nursing, Nutrition and Dietetics, Medical Technology and Kinesiology in the Clinical Simulation Centres (CSC) of the Coquimbo region, La Serena, Chile RESULTS: The internal consistency level for QJSC was Cronbach's Alpha = 0.963. The data fulfilled the Kaiser-Meyer-Olkin criteria for adequate sample MSA (measure of sampling adequacy) of 0.981 with an acceptable minimum of 0.500. The data also met the requirements of the Bartlett sphericity test (χ² = 53971, df = 561, p < .0001). The questionnaire showed a factorial structure of two factors which were named Active-Participatory Learning and Perception of Autonomy in learning.

CONCLUSIONS

It was concluded that the evidence on the validity and reliability of the scores for the Spanish version of the QJSC indicates that it is an adequate tool to evaluate the perception, satisfaction and learning outcomes of students in this teaching and learning methodology.

Psychometric properties of the Spanish version of a questionnaire to evaluate clinical simulation in Health Sciences degrees

OBJECTIVE

To determine the psychometric properties of the Spanish version of the Jeffries questionnaire to assess perception, satisfaction and learning results in Clinical Simulation (QJSC) for students of Health Science degrees.

METHOD

For the transcultural adaptation to the Spanish language of the QJSC questionnaire, the inverse method was applied with a back translation. Internal consistency analysis was performed to assess reliability, analysed with Cronbach's alpha, a value between 0.90 and 0.95 was considered acceptable. To establish the content validity, a factor analysis was performed, only items with factor saturations greater than 0.60 were considered for interpretation. Statistical analyses were performed with the SPSS 19 programme. The administration of the questionnaire was carried out in 10 to 12 clinical simulation training sessions according to the subject programme with 10 to 12 students per session, for high-fidelity clinical simulation between 2017 and 2018, in a sample of 443 undergraduate students of the Health Sciences degrees corresponding to Nursing, Nutrition and Dietetics, Medical Technology and Kinesiology in the Clinical Simulation Centres of the Coquimbo region, La Serena, Chile.

RESULTS

The internal consistency level for QJSC was Cronbach's Alpha = 0.963. The data fulfilled the Kaiser-Meyer-Olkin criteria for adequate sample MSA (measure of sampling adequacy) of 0.981 with an acceptable minimum of 0.500. The data also met the requirements of the Bartlett sphericity test (χ2 = 53971, df = 561, p <.0001). The questionnaire showed a factorial structure of two factors which were named Active-Participatory Learning and Perception of Autonomy in learning.

CONCLUSIONS

It was concluded that the evidence on the validity and reliability of the scores for the Spanish version of the QJSC indicates that it is an adequate tool to evaluate the perception, satisfaction and learning outcomes of students in this teaching and learning methodology.

Predictors of health professionals' satisfaction with continuing education: A cross-sectional study

OBJECTIVES

to verify which organizational, methodological, and resource-related characteristics of Continuing Health Education (CHE) help to best predict the professionals´ satisfaction.

METHOD

a cross-sectional study with multivariate logistic regressions to predict a high mean satisfaction with different dimensions of educational actions used: Overall satisfaction, Utility, Methodology, Organization and resources, and Teaching Capacity. 25,281 satisfaction questionnaires have been analysed completed by health professionals attending 1,228 training activities in Andalusia (Spain), during the period from March 2012 to April 2015.

RESULTS

the characteristics that best predict a high overall satisfaction are the following: clinical session type as opposed to the workshop (Odds Ratio [OR]=2.07, p<0.001); face-to-face attendance modality (OR=3.88, p<0.001) or semi-personal-attendance (OR=2.83, p<0.001), as opposed to e-learning; and 1-2 days in duration (OR=2.38, p<0.001) as opposed to those of between 3 and 14 days. A lower number of hours (OR=0.99, p<0.001) and a lower number of professionals (OR=0.98, p<0.05) also increase the probability. Having the educational actions accredited increases the probabilities in the following dimensions: Utility (OR=1.33, p<0.05), Methodology (OR=1.5, p<0.01) and Teaching capacity (OR=1.5, p<0.01).

CONCLUSION

the study provides relevant information on aspects that improve professional satisfaction, such as that e-learning activities should improve their content, teaching methods, and styles, or that face-to-face clinical sessions are the type of CHE with the greatest satisfaction.

[Simulation as a tool to facilitate change in healthcare organisations]

OBJECTIVE

To describe the use of simulation as a tool to support the strategic management of change in the Cantabrian Regional Health Service in Spain.

METHODS

A working group was created to: 1) define the strategic areas of innovation and change; 2) establish criteria for the selection of proposals that can be addressed with simulation; 3) analyse and select the proposals; 4) design and implement the simulation programs, and 5) evaluate results.

RESULTS

The constantly changing needs of the regional health system enabled 6 strategic areas to be identified during 2017-208: 1) efficient use of resources; 2) implementation of health plans of interest in the community; 3) patient safety improvement; 4) management of health personnel; 5) development of new professional skills, and 6) selection and implementation of new technology.

CONCLUSIONS

Clinical simulation is a useful tool to promote innovation strategies in healthcare, facilitating the adaptation of professionals and patients to change.

[Clinical simulation for quality improvement in the care of postpartum haemorrhage]

OBJECTIVE

To analyse and redesign the care process for patients with severe post-partum haemorrhage using simulation and a human factors approach.

METHODS

The project was developed between June 2016 and May 2017. The working group was created following the participatory leadership method and included professionals with knowledge and position to influence the organisation. The existing process and clinical protocols were reviewed. An in situ simulation was used to observe team performance in the hospital recovery room. Information was expanded through an open and structured interview with professionals selected for their experience in the subject matter. Task analysis was used to document the process, and a failure mode and effects analysis was made to assess system vulnerabilities. Results were mapped using a flow chart.

RESULTS

The analysis identified six groups of people working on different tasks, their activities and sequence of action, the importance of naming an explicit coordinator, the way in which information is disseminated and transformed, and the stages where it is necessary to share information and make key clinical decisions. The existing clinical protocols and the aids established in order to use the available resources were integrated, including blood draws and haemostatic agents, as well as an administration guide.

CONCLUSIONS

The analysis of the patient care process in post-partum haemorrhage using in situ simulation with a human factors perspective, including an analysis of the interaction between professionals and the system where they work, established a detailed and personalised map of the components that determine how work flows through the organisation.