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Große Lordemann A, Sommerfeldt D, Mileder L. [Latent safety threats in a pediatric emergency department: Using in situ simulation to test a new trauma room concept]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2024; 187:15-21. [PMID: 38644149 DOI: 10.1016/j.zefq.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/07/2024] [Accepted: 03/19/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION Structured emergency room concepts have been shown to contribute to patient safety. Until now there has been no uniform emergency room concept for critically ill and seriously injured children and adolescents in the emergency room at the Altona Children's Hospital in Hamburg. This concept has been newly developed in interdisciplinary cooperation and includes the use of new clinical premises as well as new responsibilities and team compositions. The introduction of new processes and rooms for handling emergencies is associated with a risk of overlooking latent safety deficiencies or detecting them only after the process has been implemented. This may have a direct impact on patient safety. Before moving to new clinical premises, in situ simulation can be helpful to identify and to resolve latent safety threats in advance. Therefore, this method was chosen to test the newly created emergency room concept in the future emergency room at the Altona Children's Hospital. METHODS Two in situ simulations were carried out in the future real emergency room. Latent safety threats detected by the observation team and the participants (medical and nursing staff of the Altona Children's Hospital from the departments of pediatric surgery, traumatology, orthopedics, pediatrics, anesthesia, intensive care medicine, radiology, emergency medicine) were collected using free text notes after the simulations and evaluated retrospectively. In order to better deal with these latent safety threats, the observations were classified into different categories: working environment (e.g., lack of equipment, unfavorable positioning of material), process (e.g., lack of defined responsibilities in the team) and other safety threats that did not fall into one of the two categories defined. RESULTS A total of 51 latent safety threats were identified during the two in situ simulations. Of these, 22 (43.1%) were assigned to the "working environment" category, 20 (39.2%) to the "process" category and 9 (17.7%) to the "other safety threats" category. Of the latent safety threats identified, 46 (90.2 %) could be resolved before the emergency room was put into operation. For the non-recoverable safety threats, safety concepts were developed in order to further minimize the risk of patient hazard. DISCUSSION With the help of this study, it could be shown that the implementation of in situ simulation before the commissioning of new clinical premises and the introduction of new processes can contribute to the detection of latent safety threats in an interdisciplinary German pediatric emergency department.
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Affiliation(s)
- Anja Große Lordemann
- Altonaer Kinderkrankenhaus gGmbH, Hamburg, Deutschland; Netzwerk Kindersimulation e.V, Tübingen, Deutschland.
| | | | - Lukas Mileder
- Netzwerk Kindersimulation e.V, Tübingen, Deutschland; Stabsstelle Clinical Skills Center, Medizinische Universität Graz, Graz, Österreich; Klinische Abteilung für Neonatologie, Univ.-Klinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich
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Mileder LP, Schwaberger B, Baik-Schneditz N, Ribitsch M, Pansy J, Raith W, Rohrleitner A, Mesaric G, Urlesberger B. Sustained decrease in latent safety threats through regular interprofessional in situ simulation training of neonatal emergencies. BMJ Open Qual 2023; 12:e002567. [PMID: 38154819 PMCID: PMC10759052 DOI: 10.1136/bmjoq-2023-002567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/17/2023] [Indexed: 12/30/2023] Open
Abstract
Simulation training at trainees' actual workplace offers benefits over traditional simulation-based team training. We prospectively investigated whether regular in situ simulation training of neonatal emergencies in an interprofessional and interdisciplinary team could be used to identify and rectify latent safety threats (LSTs).For this purpose, we conducted 1-day in situ simulation trainings at the Department of Gynaecology and Obstetrics, Feldbach, Austria, targeting anaesthesiologists, obstetricians, midwives, nurses and consultant paediatricians. Using published criteria for categorising LSTs, we collected LSTs, either recognised by trainers or training participants, categorised them qualitatively (medication, equipment, resource/system) and based on their potential for harm, discussed them with training participants, and reported them to hospital leadership.We conducted 13 trainings between June 2015 and April 2023, identifying 67 LSTs, most in the category of equipment (42/67, 62.7%), followed by resource/system (14/67, 20.9%) and medication (11/67, 16.4%). Sixty-one (91.0%) of the LSTs could be rectified by the next training. We observed a significant negative correlation between the number of delivered trainings and the frequency of identified LSTs (Pearson correlation coefficient r= -0,684, p=0.01).While we identified a higher number of LSTs in comparison to previously published studies, regular in situ simulation training of neonatal emergencies over a period of almost 8 years positively impacted patient safety, as the majority of LSTs was rectified by the next training. Even more important, the decrease in LSTs with the increasing number of delivered in situ simulation trainings underlines the sustained effect of this educational intervention.
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Affiliation(s)
- Lukas Peter Mileder
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Bernhard Schwaberger
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Nariae Baik-Schneditz
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Mirjam Ribitsch
- Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Jasmin Pansy
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Wolfgang Raith
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Angelika Rohrleitner
- Department of Anaesthesiology and Intensive Care Medicine, State Hospital Feldbach-Fürstenfeld, Feldbach, Styria, Austria
| | - Günter Mesaric
- Department of Anaesthesiology and Intensive Care Medicine, State Hospital Feldbach-Fürstenfeld, Feldbach, Styria, Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Styria, Austria
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Abstract
Virtual simulation (VS) education involves the use of virtual reality, augmented reality, mixed reality and screen-based platforms, collectively referred to as extended reality, to provide education and assessment. This novel simulation modality supports experiential learning and increases access to practice opportunities, supplementing manikin-based simulation. VS has been used successfully for neonatal resuscitation training in high and low resource settings. Virtual simulators can be used to objectively assess learner performance in neonatal resuscitation knowledge and skills. When implementing VS for neonatal resuscitation training, key considerations include matching learning objectives with suitable technology, pre-session preparation, supporting learners, and debriefing. Additional research is needed to evaluate the impact of VS applications on clinical practice and patient outcomes.
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Heidari H, Beni ZHM, Deris F. Using Kern model to design, implement, and evaluate an infection control program for improving knowledge and performance among undergraduate nursing students: a mixed methods study. BMC MEDICAL EDUCATION 2023; 23:795. [PMID: 37880731 PMCID: PMC10601198 DOI: 10.1186/s12909-023-04775-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/14/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Nurses and Nursing students are the front line of care in managing the care of infectious patients then they have more contact with patients than other students. Therefore, the aim of this study was designing, implementing and evaluating the infection control program among undergraduate nursing students using a mixed study. METHOD The mixed method approach with sequential exploratory (qualitative-quantitative) method was used. Kern model was applied in six steps included: 1-Needs assessment 2- Initial design 3- Goals and specific objectives 4- Educational strategy 5- Program implementation 6- Program evaluation. Thirty nursing students and 3 nursing faculty members were selected through purposive sampling for focus group in need assessment. Single-group semi-experimental study with a pre-test and post-test design was used in partnership with all eighth semester nursing students in program evaluation. RESULT Data analysis of focus group obtained two categories including: Need to improve knowledge in infection control and need to improve performance in infection control. With need assessment and literature review, educational content developed according to nursing students learning needs. Then, 3 faculty members prepared a course plan including goals, specific objectives, educational strategy for student assignments. One-way analysis of variance to compare the average score of knowledge, performance and its categories before, 2 weeks after the intervention and 2 months after the intervention shows a statistically significant difference (p > 0.001). Pearson's correlation coefficient shows that there is a negative linear relationship between work experience and knowledge score 2 weeks after and 2 months after the intervention (p < 0.05). CONCLUSION According to our results, it is recommended the need to revise the curriculum for the integration of the infection control program in the undergraduate nursing education. Of course, it is necessary to conduct more studies in the field by dividing this program into internship and field internship.
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Affiliation(s)
- Haydeh Heidari
- Modeling in Health Research Center, Faculty of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran
- School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Rahmatieh, PO Box 3833346699, Shahrekord, Iran
| | | | - Fatemeh Deris
- Shahrekord University of Medical Sciences, Shahrekord, Iran
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Copaescu AM, Graham F, Nadon N, Gagnon R, Robitaille A, Badawy M, Claveau D, Roches AD, Paradis J, Vincent M, Bégin P. Simulation-based education to improve management of refractory anaphylaxis in an allergy clinic. Allergy Asthma Clin Immunol 2023; 19:9. [PMID: 36710363 PMCID: PMC9885607 DOI: 10.1186/s13223-023-00764-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/14/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND High-fidelity simulations based on real-life clinical scenarios have frequently been used to improve patient care, knowledge and teamwork in the acute care setting. Still, they are seldom included in the allergy-immunology curriculum or continuous medical education. Our main goal was to assess if critical care simulations in allergy improved performance in the clinical setting. METHODS Advanced anaphylaxis scenarios were designed by a panel of emergency, intensive care unit, anesthesiology and allergy-immunology specialists and then adapted for the adult allergy clinic setting. This simulation activity included a first part in the high-fidelity simulation-training laboratory and a second at the adult allergy clinic involving actors and a high-fidelity mannequin. Participants filled out a questionnaire, and qualitative interviews were performed with staff after they had managed cases of refractory anaphylaxis. RESULTS Four nurses, seven allergy-immunology fellows and six allergy/immunologists underwent the simulation. Questionnaires showed a perceived improvement in aspects of crisis and anaphylaxis management. The in-situ simulation revealed gaps in the process, which were subsequently resolved. Qualitative interviews with participants revealed a more rapid and orderly response and improved confidence in their abilities and that of their colleagues to manage anaphylaxis. CONCLUSION High-fidelity simulations can improve the management of anaphylaxis in the allergy clinic and team confidence. This activity was instrumental in reducing staff reluctance to perform high-risk challenges in the ambulatory setting, thus lifting a critical barrier for implementing oral immunotherapy at our adult center.
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Affiliation(s)
- Ana M. Copaescu
- grid.14848.310000 0001 2292 3357Department of Medicine, Allergy-Immunology Division, Université de Montréal, Montreal, QC Canada ,grid.14709.3b0000 0004 1936 8649Department of Medicine, Division of Allergy and Clinical Immunology, McGill University Health Centre (MUHC), McGill University, Montreal, QC Canada ,grid.14848.310000 0001 2292 3357Department of Medicine, Université de Montréal, Montreal, QC Canada
| | - Francois Graham
- grid.14848.310000 0001 2292 3357Department of Medicine, Allergy-Immunology Division, Université de Montréal, Montreal, QC Canada ,grid.14848.310000 0001 2292 3357Department of Medicine, Université de Montréal, Montreal, QC Canada
| | - Nathalie Nadon
- grid.410559.c0000 0001 0743 2111Learning and Simulation Center, CHUM Academy, Montreal, QC Canada
| | - Rémi Gagnon
- grid.23856.3a0000 0004 1936 8390Department of Medicine, Allergy-Immunology Division, Université Laval, Quebec, QC Canada
| | - Arnaud Robitaille
- grid.14848.310000 0001 2292 3357Department of Anesthesiology, Université de Montréal, Montreal, QC Canada
| | - Mohamed Badawy
- grid.416102.00000 0004 0646 3639Department of Anesthesiology, Montreal Neurological Institute and Hospital, Montreal, QC Canada
| | - David Claveau
- grid.14848.310000 0001 2292 3357Department of Emergency, Université de Montréal, Montreal, QC Canada
| | - Anne Des Roches
- grid.14848.310000 0001 2292 3357Department of Medicine, Allergy-Immunology Division, Université de Montréal, Montreal, QC Canada
| | - Jean Paradis
- grid.14848.310000 0001 2292 3357Department of Medicine, Allergy-Immunology Division, Université de Montréal, Montreal, QC Canada
| | - Matthieu Vincent
- grid.86715.3d0000 0000 9064 6198Department of Emergency, Hôpital Charles-Le Moyne, Université de Sherbrooke, Greenfield Park, QC Canada ,grid.14848.310000 0001 2292 3357Department of Emergency, CHU Sainte-Justine, Université de Montréal, Montreal, QC Canada
| | - Philippe Bégin
- grid.14848.310000 0001 2292 3357Department of Medicine, Allergy-Immunology Division, Université de Montréal, Montreal, QC Canada ,grid.14848.310000 0001 2292 3357Department of Medicine, Université de Montréal, Montreal, QC Canada
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Truchot J, Boucher V, Li W, Martel G, Jouhair E, Raymond-Dufresne É, Petrosoniak A, Emond M. Is in situ simulation in emergency medicine safe? A scoping review. BMJ Open 2022; 12:e059442. [PMID: 36219737 PMCID: PMC9301797 DOI: 10.1136/bmjopen-2021-059442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To provide an overview of the available evidence regarding the safety of in situ simulation (ISS) in the emergency department (ED). DESIGN Scoping review. METHODS Original articles published before March 2021 were included if they investigated the use of ISS in the field of emergency medicine. INFORMATION SOURCES MEDLINE, EMBASE, Cochrane and Web of Science. RESULTS A total of 4077 records were identified by our search strategy and 2476 abstracts were screened. One hundred and thirty full articles were reviewed and 81 full articles were included. Only 33 studies (40%) assessed safety-related issues, among which 11 chose a safety-related primary outcome. Latent safety threats (LSTs) assessment was conducted in 24 studies (30%) and the cancellation rate was described in 9 studies (11%). The possible negative impact of ISS on real ED patients was assessed in two studies (2.5%), through a questionnaire and not through patient outcomes. CONCLUSION Most studies use ISS for systems-based or education-based applications. Patient safety during ISS is often evaluated in the context of identifying or mitigating LSTs and rarely on the potential impact and risks to patients simultaneously receiving care in the ED. Our scoping review identified knowledge gaps related to the safe conduct of ISS in the ED, which may warrant further investigation.
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Affiliation(s)
- Jennifer Truchot
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
- Emergency Department, CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Emergency Department, CHU Cochin- Université de Paris, APHP, Paris, France
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Valérie Boucher
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Quebec, Canada
| | - Winny Li
- 5Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Guillaume Martel
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
| | - Eva Jouhair
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Éliane Raymond-Dufresne
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
- Emergency Department, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Andrew Petrosoniak
- 5Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Emergency Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Marcel Emond
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
- Emergency Department, CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Quebec, Canada
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Evans K, Woodruff J, Cowley A, Bramley L, Miles G, Ross A, Cooper J, Baxendale B. GENESISS 2-Generating Standards for In-Situ Simulation project: a systematic mapping review. BMC MEDICAL EDUCATION 2022; 22:537. [PMID: 35818052 PMCID: PMC9272657 DOI: 10.1186/s12909-022-03401-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In-situ simulation is increasingly employed in healthcare settings to support learning and improve patient, staff and organisational outcomes. It can help participants to problem solve within real, dynamic and familiar clinical settings, develop effective multidisciplinary team working and facilitates learning into practice. There is nevertheless a reported lack of a standardised and cohesive approach across healthcare organisations. The aim of this systematic mapping review was to explore and map the current evidence base for in-situ interventions, identify gaps in the literature and inform future research and evaluation questions. METHODS A systematic mapping review of published in-situ simulation literature was conducted. Searches were conducted on MEDLINE, EMBASE, AMED, PsycINFO, CINAHL, MIDIRS and ProQuest databases to identify all relevant literature from inception to October 2020. Relevant papers were retrieved, reviewed and extracted data were organised into broad themes. RESULTS Sixty-nine papers were included in the mapping review. In-situ simulation is used 1) as an assessment tool; 2) to assess and promote system readiness and safety cultures; 3) to improve clinical skills and patient outcomes; 4) to improve non-technical skills (NTS), knowledge and confidence. Most studies included were observational and assessed individual, team or departmental performance against clinical standards. There was considerable variation in assessment methods, length of study and the frequency of interventions. CONCLUSIONS This mapping highlights various in-situ simulation approaches designed to address a range of objectives in healthcare settings; most studies report in-situ simulation to be feasible and beneficial in addressing various learning and improvement objectives. There is a lack of consensus for implementing and evaluating in-situ simulation and further studies are required to identify potential benefits and impacts on patient outcomes. In-situ simulation studies need to include detailed demographic and contextual data to consider transferability across care settings and teams and to assess possible confounding factors. Valid and reliable data collection tools should be developed to capture the complexity of team and individual performance in real settings. Research should focus on identifying the optimal frequency and length of in-situ simulations to improve outcomes and maximize participant experience.
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Affiliation(s)
- Kerry Evans
- Nottingham University Hospitals Trust, Institute of Care Excellence, Nottingham, UK
| | | | - Alison Cowley
- Nottingham University Hospitals Trust, Research & Innovation, Nottingham, UK
| | - Louise Bramley
- Nottingham University Hospitals Trust, Institute of Care Excellence, Nottingham, UK
| | - Giulia Miles
- Trent Simulation & Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, Notts UK
| | - Alastair Ross
- Glasgow Dental School, University of Glasgow, Glasgow, UK
| | - Joanne Cooper
- Nottingham University Hospitals Trust, Institute of Care Excellence, Nottingham, UK
| | - Bryn Baxendale
- Trent Simulation & Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, Notts UK
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Baxendale B, Evans K, Cowley A, Bramley L, Miles G, Ross A, Dring E, Cooper J. GENESISS 1-Generating Standards for In-Situ Simulation project: a scoping review and conceptual model. BMC MEDICAL EDUCATION 2022; 22:479. [PMID: 35725432 PMCID: PMC9208746 DOI: 10.1186/s12909-022-03490-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/23/2022] [Indexed: 05/04/2023]
Abstract
BACKGROUND In-Situ Simulation (ISS) enables teams to rehearse and review practice in the clinical environment to facilitate knowledge transition, reflection and safe learning. There is increasing use of ISS in healthcare organisations for which patient safety and quality improvement are key drivers. However, the effectiveness of ISS interventions has not yet been fully demonstrated and requires further study to maximise impact. Cohesive programmatic implementation is lacking and efforts to standardise ISS terms and concepts, strengthen the evidence base and develop an integrated model of learning is required. The aim of this study was to explore the current evidence, theories and concepts associated with ISS across all areas of healthcare and develop a conceptual model to inform future ISS research and best practice guidance. METHODS A scoping review was undertaken with stakeholder feedback to develop a conceptual model for ISS. Medline, OpenGrey and Web of Science were searched in September 2018 and updated in December 2020. Data from the included scoping review studies were analysed descriptively and organised into categories based on the different motivations, concepts and theoretical approaches for ISS. Categories and concepts were further refined through accessing stakeholder feedback. RESULTS Thirty-eight papers were included in the scoping review. Papers reported the development and evaluation of ISS interventions. Stakeholder groups highlighted situations where ISS could be suitable to improve care and outcomes and identified contextual and practical factors for implementation. A conceptual model of ISS was developed which was organised into four themes: 1. To understand and explore why systematic events occur in complex settings; 2.To design and test new clinical spaces, equipment, information technologies and procedures; 3. To practice and develop capability in individual and team performance; 4. To assess competency in complex clinical settings. CONCLUSIONS ISS presents a promising approach to improve individual and team capabilities and system performance and address the 'practice-theory gap'. However, there are limitations associated with ISS such as the impact on the clinical setting and service provision, the reliance of having an open learning culture and availability of relevant expertise. ISS should be introduced with due consideration of the specific objectives and learning needs it is proposed to address. Effectiveness of ISS has not yet been established and further research is required to evaluate and disseminate the findings of ISS interventions.
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Affiliation(s)
- Bryn Baxendale
- Trent Simulation & Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, Notts UK
| | - Kerry Evans
- Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Alison Cowley
- Nottingham University Hospitals NHS Trust, Research and Innovation, Nottingham, UK
| | - Louise Bramley
- Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Guilia Miles
- Trent Simulation & Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, Notts UK
| | - Alastair Ross
- Glasgow Dental School, University of Glasgow, Glasgow, UK
| | - Eleanore Dring
- Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Joanne Cooper
- Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Simma L, Stocker M, Lehner M, Wehrli L, Righini-Grunder F. Critically Ill Children in a Swiss Pediatric Emergency Department With an Interdisciplinary Approach: A Prospective Cohort Study. Front Pediatr 2021; 9:721646. [PMID: 34708009 PMCID: PMC8544259 DOI: 10.3389/fped.2021.721646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: Delivery of prompt and adequate care for critically ill and injured children presenting to the pediatric emergency department (PED) is paramount for optimal outcomes. Knowledge of the local epidemiology, patient profile, and presentation modes are key for organizational planning, staff education strategy, and optimal care in a PED. Our aim was to analyze the profile of critically ill and injured children admitted to a tertiary, non-academic Swiss PED, to investigate potential risk factors associated with admission to the pediatric intensive care unit (PICU), and the outcomes mortality and PICU admission. Methods: Prospective cohort study of critically ill and injured children presenting to the PED over a two-year period (2018-2019). Inclusion criteria were Australasian triage scale category (ATS) 1, trauma team activation (TTA), medical emergency response (MER) activation, additional critical care consult, and transfer to an outside hospital. Results: Of 42,579 visits during the two-year period, 347 presentations matched the inclusion criteria (0.81%). Leading presentations were central nervous system (CNS) disorders (26.2%), trauma (25.1%), and respiratory emergencies (24.2%). 288 out of 347 cases (83%) arrived during the day or evening with an even distribution over the days of the week. 128 out of 347 (37%) arrived unexpectedly as walk-ins. 233 (67.15%) were ATS category 1. 51% of the cohort was admitted to PICU. Australasian triage scale category 1 was significantly more common in this group (p = 0.0001). Infants with respiratory disease had an increased risk of PICU transfer compared to other age groups (OR 4.18 [95%CI 2.46, 7.09] p = 0.0001), and this age group presented mainly as walk-in (p = 0.0001). Pediatric intensive care unit admissions had a longer hospital stay (4 [2, 8] days vs. 2 [1, 4] days, p = 0.0001) compared to other patients. 0.045% of all PED patients had to be transferred out. Three deaths (0.86%) occurred in the PED, 10 patients died in the PICU (2.9%). Conclusions: High acuity presentations in the PED were rare, more likely to be young with CNS disorders, trauma and respiratory diseases. A significant proportion were unexpected walk-in presentations, mainly during day and evening shifts. Low exposure to high-acuity patients highlights the importance of deliberate learning and simulation for all professionals in the PED.
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Affiliation(s)
- Leopold Simma
- Emergency Department, Children's Hospital Lucerne, Lucerne, Switzerland.,Emergency Department, University's Children Hospital Zurich, Zurich, Switzerland
| | - Martin Stocker
- Neonatal and Pediatric Intensive Care, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Markus Lehner
- Department of Pediatric Surgery, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Lea Wehrli
- Department of Pediatric Surgery, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Franziska Righini-Grunder
- Division of Pediatric Gastroenterology, Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
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Shah S, McGowan M, Petrosoniak A. Latent safety threat identification during in situ simulation debriefing: a qualitative analysis. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:194-198. [PMID: 35516823 PMCID: PMC8936644 DOI: 10.1136/bmjstel-2020-000650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 11/03/2022]
Abstract
Background Latent safety threats (LSTs) in healthcare are hazards or conditions that risk patient safety but are not readily apparent without system stress. In situ simulation (ISS), followed by post-scenario debriefing is a common method to identify LSTs within the clinical environment. The function of post-ISS debriefing for LST identification is not well understood. Objectives This study aims to qualitatively characterise the types of LSTs identified during ISS debriefing. Methods We conducted 12 ISS trauma scenarios followed by debriefing at a Canadian, Level 1 trauma centre. We designed the scenarios and debriefing for 15 and 20 min, respectively. Debriefings focused on LST identification, and each session was audio recorded and transcribed. We used an inductive approach with qualitative content analysis to code text data into an initial coding tree. We generated refined topics from the coded text data. Results We identified five major topics: (1) communication and teamwork challenges, (2) system-level issues, (3) resource constraints, (4) positive team performance and (5) potential improvements to the current systems and processes. Conclusions During simulation debriefing sessions for LST identification, participants discussed threats related to communication and interpersonal issues. Safety issues relating to equipment, processes and the physical space received less emphasis. These findings may guide health system leaders and simulation experts better understanding of the strengths and limitations of simulation debriefing for LST identification. Further studies are required to compare ISS-based LST identification techniques.
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Affiliation(s)
- Sparsh Shah
- Department of Medicine, University of Toronto Faculty of Medicine, Toronto, Canada
| | - Melissa McGowan
- Department of Emergency Medicine, St. Michael’s Hospital, Toronto, Canada
| | - Andrew Petrosoniak
- Department of Medicine, University of Toronto Faculty of Medicine, Toronto, Canada
- Department of Emergency Medicine, St. Michael’s Hospital, Toronto, Canada
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11
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Mastoras G, Poulin C, Norman L, Weitzman B, Pozgay A, Frank JR, Posner G. Stress Testing the Resuscitation Room: Latent Threats to Patient Safety Identified During Interprofessional In Situ Simulation in a Canadian Academic Emergency Department. AEM EDUCATION AND TRAINING 2020; 4:254-261. [PMID: 32704595 PMCID: PMC7369481 DOI: 10.1002/aet2.10422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Emergency department (ED) resuscitation is a complex, high-stakes procedure where positive outcomes depend on effective interactions between the health care team, the patient, and the environment. Resuscitation teams work in dynamic environments and strive to ensure the timely delivery of necessary treatments, equipment, and skill sets when required. However, systemic failures in this environment cannot always be adequately anticipated, which exposes patients to opportunities for harm. METHODS As part of a new interprofessional education and quality improvement initiative, this prospective, observational study sought to characterize latent safety threats (LSTs) identified during the delivery of in situ, simulated resuscitations in our ED. In situ simulation (ISS) sessions were delivered on a monthly basis in the EDs at each campus of a large tertiary care academic hospital system, during which a variety of scenarios were run with teams of ED health care professionals. LSTs were identified by simulation facilitators and participants during the case and debriefing and then grouped thematically for analysis. RESULTS During the study period, 22 ISS sessions were delivered, involving 58 cases and reaching 383 ED health care professionals. 196 latent safety threats were identified through these sessions (mean = 3.4 LSTs per case) of which 110 were determined to be "actionable" at a system level. LSTs identified included system/environmental design flaws, equipment problems, failures in department processes, and knowledge/skill gaps. Corrective mechanisms were initiated in 85% of actionable cases. CONCLUSIONS Effective quality improvement and continuing education programs are essential to translate these findings into more resilient patient care. ISS, beyond its role as a training tool for developing intrinsic and crisis resource management skills, can be effectively used to identify system issues in the ED that could expose critically ill patients to harm.
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Affiliation(s)
- George Mastoras
- Department of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntario
| | - Cari Poulin
- Department of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntario
| | - Larry Norman
- Department of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntario
| | - Brian Weitzman
- Department of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntario
| | - Anita Pozgay
- Department of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntario
| | - Jason R. Frank
- Department of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntario
- Royal College of Physicians and Surgeons of CanadaOttawaOntarioCanada
| | - Glenn Posner
- Department of Obstetrics and GynecologyFaculty of MedicineUniversity of OttawaOttawaOntario
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12
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Walsh BM, Wong AH, Ray JM, Frallicciardi A, Nowicki T, Medzon R, Bentley S, Stapleton S. Practice Makes Perfect. Emerg Med Clin North Am 2020; 38:363-382. [DOI: 10.1016/j.emc.2020.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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13
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Abstract
Teamwork is essential for health care providers, who must work together to ensure safe and effective patient care. The ability to function effectively as a team is especially important in critical care, where ad hoc teams are brought together for short-term management of crisis situations. Teamwork training has been widely implemented, but ongoing education and practice are needed to maintain and improve competency. This article reviews some of the literature on team science and provides recommendations for enhancing training to promote development of a shared mental model. Strategies such as ensuring multidisciplinary participation, clarifying team resources and goals, and creating practice scenarios can increase the effectiveness of training for critical care teams. Evaluation can provide immediate feedback on learning outcomes and may facilitate subsequent transfer of learning to the clinical setting. Interventions that improve a team's ability to work toward a common goal can improve outcomes for critically ill patients.
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Affiliation(s)
- Joni L Dirks
- Joni L. Dirks is manager, clinical education, Department of Professional Development, Providence Health Care, Spokane, Washington.
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14
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Walsh BM, Auerbach MA, Gawel MN, Brown LL, Byrne BJ, Calhoun A. Community-based in situ simulation: bringing simulation to the masses. Adv Simul (Lond) 2019; 4:30. [PMID: 31890313 PMCID: PMC6925415 DOI: 10.1186/s41077-019-0112-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
Simulation-based methods are regularly used to train inter-professional groups of healthcare providers at academic medical centers (AMC). These techniques are used less frequently in community hospitals. Bringing in-situ simulation (ISS) from AMCs to community sites is an approach that holds promise for addressing this disparity. This type of programming allows academic center faculty to freely share their expertise with community site providers. By creating meaningful partnerships community-based ISS facilitates the communication of best practices, distribution of up to date policies, and education/training. It also provides an opportunity for system testing at the community sites. In this article, we illustrate the process of implementing an outreach ISS program at community sites by presenting four exemplar programs. Using these exemplars as a springboard for discussion, we outline key lessons learned discuss barriers we encountered, and provide a framework that can be used to create similar simulation programs and partnerships. It is our hope that this discussion will serve as a foundation for those wishing to implement community-based, outreach ISS.
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Affiliation(s)
- Barbara M Walsh
- 1Department of Pediatrics, Division of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, 818 Harrison Ave, Vose 5, Boston, MA 02118 USA
| | - Marc A Auerbach
- 2Department of Pediatrics, Yale University School of Medicine, New Haven, USA
| | | | - Linda L Brown
- 4Department of Pediatrics and Emergency Medicine, Alpert Medical School of Brown University, Providence, USA
| | - Bobbi J Byrne
- 5Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA
| | - Aaron Calhoun
- 6Department of Pediatrics, University of Louisville School of Medicine, Louisville, USA
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15
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Anderson M, Campbell SH, Nye C, Diaz D, Boyd T. Simulation in Advanced Practice Education: Let's Dialogue!! Clin Simul Nurs 2019. [DOI: 10.1016/j.ecns.2018.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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O'Leary F, Pegiazoglou I, McGarvey K, Novakov R, Wolfsberger I, Peat J. Realism in paediatric emergency simulations: A prospective comparison of in situ, low fidelity and centre-based, high fidelity scenarios. Emerg Med Australas 2017; 30:81-88. [PMID: 29143446 DOI: 10.1111/1742-6723.12885] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 07/25/2017] [Accepted: 09/24/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To measure scenario participant and faculty self-reported realism, engagement and learning for the low fidelity, in situ simulations and compare this to high fidelity, centre-based simulations. METHODS A prospective survey of scenario participants and faculty completing in situ and centre-based paediatric simulations. RESULTS There were 382 responses, 276 from scenario participants and 106 from faculty with 241 responses from in situ and 141 from centre-based simulations. Scenario participant responses showed significantly higher ratings for the centre-based simulations for respiratory rate (P = 0.007), pulse (P = 0.036), breath sounds (P = 0.002), heart sounds (P < 0.001) and patient noises (P < 0.001). There was a significant difference in overall rating of the scenario reality by scenario participants in favour of the centre-based simulations (P = 0.005); however, there was no significant difference when rating participant engagement (P = 0.11) and participant learning (P = 0.77). With the centre-based scenarios, nurses rated the reality of the respiratory rate (P < 0.001), blood pressure (P = 0.016) and abdominal signs (P = 0.003) significantly higher than doctors. Nurses rated the overall reality higher than doctors for the centre simulations (96.8% vs 84.2% rated as realistic, P = 0.041), which was not demonstrated in the in situ scenarios (76.2% vs 73.5%, P = 0.65). CONCLUSION Some aspects of in situ simulations may be less 'real' than centre-based simulations, but there was no significant difference in self-reported engagement or learning by scenario participants. Low fidelity, in situ simulation provides adequate realism for engagement and learning.
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Affiliation(s)
- Fenton O'Leary
- Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Disciplines of Emergency Medicine and Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Ioannis Pegiazoglou
- Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Disciplines of Emergency Medicine and Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kathryn McGarvey
- Disciplines of Emergency Medicine and Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Ruza Novakov
- Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Ingrid Wolfsberger
- Kids Simulation Australia, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Jennifer Peat
- Australian Catholic University, Sydney, New South Wales, Australia
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17
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Mann JA, Roland D. What are the measures that can be used to assess performance during in situ Paediatric Emergency Medicine Simulation? BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2017; 3:83-87. [PMID: 35518909 PMCID: PMC8990193 DOI: 10.1136/bmjstel-2016-000140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 12/07/2016] [Accepted: 02/17/2017] [Indexed: 12/29/2022]
Abstract
Background Paediatric in situ simulation within emergency departments is growing in popularity as an approach for improving multidisciplinary team working, enabling clinical skills development and exploring the importance of human factors in the clinical setting. However, measuring the success of such programmes is often through participant feedback of satisfaction and not measures of performance, which makes it difficult to assess whether such programmes lead to improvements in clinical behaviour. Objective To identify the measures that can be used to assess performance during in situ paediatric emergency medicine simulations. Study selection A literature search of EMBASE, ERIC and MEDLINE was performed using the key terms (Paediatrics and Emergency and Simulation.) MeSH and subheadings were used to ensure all possible variations of the key terms were included within the search. Findings The search revealed 607 articles, with 16 articles meeting inclusion criteria. Three themes of evaluation strategy were identified-the use of feedback forms (56% n=9/16), performance evaluation methods (63% n=10/16) or other strategies (25% n=4/16), which included provider comfort scores, latent safety threat identification and episodes of suboptimal care and their causation. Conclusions The most frequently used method of assessment in paediatric emergency department simulation are performance evaluation methods. None of the studies in this area have looked at patient level outcomes and this is therefore an area which should be explored in the future.
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Affiliation(s)
- Jennifer Amanda Mann
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Paediatric Emergency Department, Leicester Royal Infirmary, Leicester, UK
- SAPPHIRE group, Health Sciences, Leicester University, Leicester, UK
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Paediatric Emergency Department, Leicester Royal Infirmary, Leicester, UK
- SAPPHIRE group, Health Sciences, Leicester University, Leicester, UK
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18
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Stocker M, Laine K, Ulmer F. Use of simulation-based medical training in Swiss pediatric hospitals: a national survey. BMC MEDICAL EDUCATION 2017; 17:104. [PMID: 28623922 PMCID: PMC5473998 DOI: 10.1186/s12909-017-0940-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 06/09/2017] [Indexed: 06/09/2023]
Abstract
BACKGROUND Simulation-based medical training (SBMT) is a powerful tool for continuing medical education. In contrast to the Anglo-Saxon medical education community, up until recently, SBMT was scarce in continental Europe's pediatric health care education: In 2009, only 3 Swiss pediatric health care institutions used SBMT. The Swiss catalogue of objectives in Pediatrics does not acknowledge SBMT. The aim of this survey is to describe and analyze the current state of SBMT in Swiss pediatric hospitals and health care departments. METHODS A survey was carried out with medical education representatives of every institution. SBMT was defined as any kind of training with a mannequin excluding national and/or international standardized courses. The survey reference day was May 31st 2015. RESULTS Thirty Swiss pediatric hospitals and health care departments answered our survey (response rate 96.8%) with 66.6% (20 out of 30) offering SBMT. Four of the 20 hospitals offering SMBT had two independently operating training simulation units, resulting in 24 educational units as the basis for our SBMT analysis. More than 90% of the educational units offering SBMT (22 out of 24 units) were conducting in-situ training and 62.5% (15 out of 24) were using high-technology mannequins. Technical skills, communication and leadership ranked among the top training priorities. All institutions catered to inter-professional participants. The vast majority conducted training that was neither embedded within a larger educational curriculum (19 out of 24: 79.2%) nor evaluated (16 out of 24: 66.6%) by its participants. Only 5 institutions (20.8%) extended their training to at least two thirds of their hospital staff. CONCLUSIONS Two thirds of the Swiss pediatric hospitals and health care departments are offering SBMT. Swiss pediatric SBMT is inter-professional, mainly in-situ based, covering technical as well as non-technical skills, and often employing high-technology mannequins. The absence of a systematic approach and reaching only a small number of healthcare employees were identified as shortcomings that need to be addressed.
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Affiliation(s)
- Martin Stocker
- Pediatric and Neonatal Intensive Care Unit, Children’s Hospital Lucerne, Spitalstrasse 16, CH-6000 Luzern, Switzerland
| | - Kathryn Laine
- Department of Pediatrics, University Hospital Lausanne, Lausanne, Switzerland
| | - Francis Ulmer
- Pediatric Intensive Care Unit, Children’s Hospital, University Hospital Berne, Bern, Switzerland
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19
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Brewster DJ, Barrett JA, Gherardin E, O'Neill JA, Sage D, Hanlon G. Evaluating team-based inter-professional advanced life support training in intensive care-a prospective observational study. Anaesth Intensive Care 2017; 45:79-87. [PMID: 28072939 DOI: 10.1177/0310057x1704500112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent focus on national standards within Australian hospitals has prompted a focus on the training of our staff in advanced life support (ALS). Research in critical care nursing has questioned the traditional annual certification of ALS competence as the best method of delivering this training. Simulation and team-based training may provide better ALS education to intensive care unit (ICU) staff. Our new inter-professional team-based advanced life support program involved ICU staff in a large private metropolitan ICU. A prospective observational study using three standardised questionnaires and two multiple choice questionnaire assessments was conducted. Ninety-nine staff demonstrated a 17.8% (95% confidence interval 4.2-31, P=0.01) increase in overall ICU nursing attendance at training sessions. Questionnaire response rates were 93 (94%), 99 (100%) and 60 (61%) respectively; 51 (52%) staff returned all three. Criteria were assessed by scores from 0 to 10. Nurses reported improved satisfaction with the education program (9.4 to 7.1, P <0.001), as well as improvement in role understanding (8.7 and 9.1 versus 7.9 and 8.2, P <0.001) and confidence (8.4 and 8.8 versus 7.4 and 7.8, P <0.001) during ALS provision (outside ICU and inside ICU) following the course when compared to before the program. Doctors' only statistically significant improvement was in their confidence in ALS provision outside ICU (8.7 versus 8.1, P=0.04). The new program cost approximately an extra $16,500 in nursing salaries. We concluded that team-based, inter-professional ALS training produced statistically significant improvements in nursing attendance, satisfaction with ALS education, confidence and role understanding compared to traditional ALS training.
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Affiliation(s)
- D J Brewster
- Intensive Care Specialist, Intensive Care Unit, Cabrini Health, Adjunct Lecturer, Monash University, Melbourne, Victoria
| | - J A Barrett
- Intensive Care Specialist, Intensive Care Unit, Cabrini Health, Adjunct Lecturer, Monash University, Melbourne, Victoria
| | - E Gherardin
- Critical Care Educator, Intensive Care Unit, Cabrini Health, Melbourne, Victoria
| | - J A O'Neill
- Critical Care Educator, Intensive Care Unit, Cabrini Health, Melbourne, Victoria
| | - D Sage
- Nurse Unit Manager, Intensive Care Unit, Cabrini Health, Melbourne, Victoria
| | - G Hanlon
- Research Coordinator, Intensive Care Unit, Cabrini Health, Melbourne, Victoria
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20
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Egenberg S, Øian P, Eggebø TM, Arsenovic MG, Bru LE. Changes in self-efficacy, collective efficacy and patient outcome following interprofessional simulation training on postpartum haemorrhage. J Clin Nurs 2017; 26:3174-3187. [DOI: 10.1111/jocn.13666] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2016] [Indexed: 01/27/2023]
Affiliation(s)
- Signe Egenberg
- Department of Obstetrics and Gynaecology; Stavanger University Hospital; Stavanger Norway
| | - Pål Øian
- Department of Obstetrics and Gynaecology; University Hospital of North Norway; Tromsø Norway
- Women's Health and Perinatology Research Group; Department of Clinical Medicine; University of Tromsø; Tromsø Norway
| | - Torbjørn Moe Eggebø
- Department of Obstetrics and Gynaecology; Stavanger University Hospital; Stavanger Norway
- National Center for Fetal Medicine; Trondheim University Hospital; Trondheim Norway
| | - Mirjana Grujic Arsenovic
- Division of Immunology and Transfusion Medicine; Department of Laboratory Medicine; University Hospital of North Norway; Tromsø Norway
| | - Lars Edvin Bru
- Department of Health Studies; University of Stavanger; Stavanger Norway
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21
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Kothari LG, Shah K, Barach P. Simulation based medical education in graduate medical education training and assessment programs. PROGRESS IN PEDIATRIC CARDIOLOGY 2017. [DOI: 10.1016/j.ppedcard.2017.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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22
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Brown LL, Overly FL. Simulation-Based Interprofessional Team Training. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2016. [DOI: 10.1016/j.cpem.2016.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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