A systematic literature review of simulation models for non-technical skill training in healthcare logistics

Nursing students led simulations to improve healthcare workers' hand hygiene compliance

BACKGROUND

Hand hygiene compliance (HHC) is recognised as a major factor in the prevention of healthcare-associated infections. Healthcare workers (HCWs) compliance is still suboptimal. Simulation as an educational strategy may contribute to improved performance.

OBJECTIVE

This study aimed to assess the effect of simulation interventions led by nursing students on HCWs' HHC.

METHOD

A prospective quasi-experimental design with before and after intervention measurements was implemented in an 1150-bed tertiary hospital. Four consecutive periods, measuring before and after HHC, were examined in four hospital divisions. For each division, unique simulation activities were developed and led by nursing students, educators, and hospital leaders. Sixty seven students and 286 healthcare workers, along with two nurse educators, participated in the simulation sessions. HHC of all HCWs in the divisions was assessed by hospital infection control personnel.

RESULTS

Hospital HHC rose across the four periods in all four divisions during this study. In three out of four periods and divisions, HHC increased significantly more in the simulation intervention groups compared to the overall hospital improvement.

CONCLUSION

Student-led simulation for HCWs is an additional effective method to improve HHC. Nursing managers should consider joining forces with nursing educators to enable students to become agents of change in healthcare settings and encourage further collaboration.

Which, how, and what? Using digital tools to train surgical skills; a systematic review and meta-analysis

Background

Digital tools like digital box trainers and VR seem promising in delivering safe and tailored practice opportunities outside of the surgical clinic, yet understanding their efficacy and limitations is essential. This study investigated Which digital tools are available to train surgical skills, How these tools are used, How effective they are, and What skills they are intended to teach.

Methods

Medline, Embase, and Cochrane libraries were systematically reviewed for randomized trials, evaluating digital skill-training tools based on objective outcomes (skills scores and completion time) in surgical residents. Digital tools effectiveness were compared against controls, wet/dry lab training, and other digital tools. Tool and training factors subgroups were analysed, and studies were assessed on their primary outcomes: technical and/or non-technical.

Results

The 33 included studies involved 927 residents and six digital tools; digital box trainers, (immersive) virtual reality (VR) trainers, robot surgery trainers, coaching and feedback, and serious games. Digital tools outperformed controls in skill scores (SMD 1.66 [1.06, 2.25], P < 0.00001, I2 = 83 %) and completion time (SMD -1.05 [-1.72, -0.38], P = 0.0001, I2 = 71 %). There were no significant differences between digital tools and lab training, between tools, or in other subgroups. Only two studies focussed on non-technical skills.

Conclusion

While the efficacy of digital tools in enhancing technical surgical skills is evident - especially for VR-trainers -, there is a lack of evidence regarding non-technical skills, and need to improve methodological robustness of research on new (digital) tools before they are implemented in curricula.

Key message

This study provides critical insight into the increasing presence of digital tools in surgical training, demonstrating their usefulness while identifying current challenges, especially regarding methodological robustness and inattention to non-technical skills.

A Literature Study of Medical Simulations for Non-Technical Skills Training in Emergency Medicine: Twenty Years of Progress, an Integrated Research Framework, and Future Research Avenues

Medical simulations have led to extensive developments in emergency medicine. Apart from the growing number of applications and research efforts in patient safety, few studies have focused on modalities, research methods, and professions via a synthesis of simulation studies with a focus on non-technical skills training. Intersections between medical simulation, non-technical skills training, and emergency medicine merit a synthesis of progress over the first two decades of the 21st century. Drawing on research from the Web of Science Core Collection's Science Citation Index Expanded and Social Science Citation Index editions, results showed that medical simulations were found to be effective, practical, and highly motivating. More importantly, simulation-based education should be a teaching approach, and many simulations are utilised to substitute high-risk, rare, and complex circumstances in technical or situational simulations. (1) Publications were grouped by specific categories of non-technical skills, teamwork, communication, diagnosis, resuscitation, airway management, anaesthesia, simulation, and medical education. (2) Although mixed-method and quantitative approaches were prominent during the time period, further exploration of qualitative data would greatly contribute to the interpretation of experience. (3) High-fidelity dummy was the most suitable instrument, but the tendency of simulators without explicitly stating the vendor selection calls for a standardised training process. The literature study concludes with a ring model as the integrated framework of presently known best practices and a broad range of underexplored research areas to be investigated in detail.

Learning to See: Using Mixed OR Methods to Model Radiology Staff Workload and Support Decision Making in CT

Demand for Computer Tomography (CT) is growing year on year and the population of Ireland is increasingly aging and ailing. Anecdotally, radiology staff reported increasing levels of workload associated with the patient profile. In this paper, we propose a framework combining discrete event simulation (DES) modeling and soft systems methodologies (SSM) for use in healthcare which captures the staff experience and metrics to evidence workload. The framework was applied in a single-scanner CT department, which completes circa 6000 examinations per year. The scanner case load consists of unscheduled work [inpatient (IP) and emergency department (ED)] and scheduled work [outpatient (OP) and general practitioner (GP)]. The three stage framework is supported by qualitative and quantitative methods and uses DES as a decision support tool. Firstly, workflow mapping and system dynamics are used to conceptualize the problem situation and instigate a preliminary data analysis. Secondly, SSM tools are used to identify components for a DES model and service improvement scenarios. Lastly, the DES model results are used to inform decision-making and identify a satisficing solution. Data from the DES model provided evidence of the differing workload (captured in staff time) for the IP and OP cohorts. For non-contrast examinations, inpatient workload is 2.5 times greater than outpatient. Average IP process delays of 11.9 min were demonstrated compared to less than 1 min for OP. The findings recommend that OP and IP diagnostic imaging be provided separately, for efficiency, workload management and infection control reasons.

Externalities of Lean Implementation in Medical Laboratories. Process Optimization vs. Adaptation and Flexibility for the Future

Important in testing services in medical laboratories is the creation of a flexible balance between quality-response time and minimizing the cost of the service. Beyond the different Lean methods implemented so far in the medical sector, each company can adapt the model according to its needs, each company has its own specifics and organizational culture, and Lean implementation will have a unique approach. Therefore, this paper aims to identify the concerns of specialists and laboratory medical services sector initiatives in optimizing medical services by implementing the Lean Six Sigma method in its various variants: a comparative analysis of the implemented models, with emphasis on measuring externalities and delimiting trends in reforming/modernizing the method, a comprehensive approach to the impact of this method implementation, and an analysis of available databases in order to underline the deficit and information asymmetry. The results highlighted that in the case of clinical laboratories, the Lean Six Sigma method is conducive to a reduction of cases of diagnostic errors and saves time but also faces challenges and employees' resistance in implementation.

Game Experience and Learning Effects of a Scoring-Based Mechanic for Logistical Aspects of Pediatric Emergency Medicine: Development and Feasibility Study

Background

Using serious games for learning in operations management is well established. However, especially for logistics skills in health care operations, there is little work on the design of game mechanics for learning engagement and the achievement of the desired learning goals.

Objective

This contribution presents a serious game design representing patient flow characteristics, systemic resource configurations, and the roles of the players based on a real Swedish emergency ward. The game was tested in a set of game-based learning practices in the modalities of a physical board game and an online multiplayer serious game that implemented the same game structure.

Methods

First, survey scores were collected using the Game Experience Questionnaire Core and Social Presence Modules to evaluate the experience and acceptance of the proposed design to gamify real processes in emergency care. Second, lag sequential analysis was applied to analyze the impact of the game mechanics on learning behavior transitions. Lastly, regression analysis was used to understand whether learning engagement attributes could potentially serve as significant predicting variables for logistical performance in a simulated learning environment.

Results

A total of 36 students from courses in engineering and management at KTH Royal Institute of Technology participated in both game-based learning practices during the autumn and spring semesters of 2019 and 2020. For the Core Module, significant differences were found for the scores for negative affect and tension compared with the rest of the module. For the Social Presence Module, significant differences were found in the scores for the psychological involvement – negative feelings dimension compared with the rest of the module. During the process of content generation, the participant had access to circulating management resources and could edit profiles. The standard regression analysis output yielded a ΔR² of 0.796 (F1_4,31=2725.49, P<.001) for the board version and 0.702 (F2_4,31=2635.31, P<.001) for the multiplayer online version after the learning engagement attributes.

Conclusions

The high scores of positive affect and immersion compared to the low scores of negative feelings demonstrated the motivating and cognitive involvement impact of the game. The proposed game mechanics have visible effects on significant correlation parameters between the majority of scoring features and changes in learning engagement attributes. Therefore, we conclude that for enhancing learning in logistical aspects of health care, serious games that are steered by well-designed scoring mechanisms can be used.

Physicians' perceptions regarding acute bleeding management: an international mixed qualitative quantitative study

Background

Acute bleeding is an omnipresent challenge for all physicians. Uncontrolled hemorrhage is the most common preventable cause of death after trauma worldwide. In different surgical disciplines, hemorrhage represents an independent risk factor for increased postoperative morbimortality, directly affecting patients’ outcomes. This study asked anesthesiologists about their personal perceived challenges when treating bleeding patients.

Methods

This investigator-initiated, prospective, international, dual-center, mixed qualitative and quantitative study interrogated anesthesiologists about what they found easy and what difficult in treating acutely bleeding patients. Following the template approach for qualitative research, we identified major and minor topics through free inductive coding and word count. In a second step, we derived ten statements from the participants’ answers. Using a field survey, we then asked the participants to rate their level of agreement with the derived statements. We analyzed the answers using one sample Wilcoxon test and the Mann-Whitney test.

Results

We included a total of 84 physicians in the qualitative interrogations and a different group of 42 anesthesiologists in the quantitative part. We identified 11 major topics and 19 associated subtopics. The main topics and the degree of agreement (here as agree or strongly agree) were as follows: “Complexity of the topic” (52.4% agreed to find the topic complex), “Cognitive aids” (92.9% agreed to find them helpful), “Time management” (64.3% agreed to feeling time pressure), “Human factors” (95.2% agreed that human factors are essential), “Resources” (95.2% agreed that resources are essential), “Experience” and “Low frequency of cases” (57.1% agreed to lack practice), “Diagnostic methods” (31.0% agreed that the interpretation of test results is difficult), “Anticoagulation” (85.7% agreed to it being difficult), “Treatment” (81.0% agreed to knowing the first therapeutic steps), and “Nothing”.

Conclusions

Anesthesiologists in two large tertiary care facilities in different parts of the world found coagulation management, especially in anticoagulated patients, complex. We identified the delayed diagnostic test results and their interpretation as challenges. Resources, treatment protocols and human factors such as team communication were perceived to facilitate management. Future studies should explore the challenges in smaller hospitals and other parts of the world and test new technologies addressing the identified difficulties.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12871-021-01269-x.

Non-Technical Skills in Social Networks: The Spread of Safety Communication and Teamwork in a Warehouse

Safety at work should be considered as the result of the daily interaction of operators. The present research wants to analyze which factors are involved in the development of social networks about safety at work. We assumed that two relational non-technical skills, such as safety communication and safety team member support, affect the in-degree and out-degree bonds of workers in social networks. One hundred and eight workers of a warehouse were the participants of the research, in which they were asked to fill out a self-reported questionnaire. Multiple linear regression analysis was used to test the hypotheses. Results confirmed that safety communication and safety support skills play a role in determining the quantity and the quality of social bonds that workers can create at the workplace. To be specific, while safety communication was found to be associated with out-degree centrality (b = 0.24; p = 0.01), a nonsignificant relationship was found for in-degree centrality. In contrast, safety team member support was found to be associated with in-degree centrality (b = 0.28; p = 0.04). In other words, on the one hand, it was found that high levels of safety communication skills are associated with the tendency of workers to proactively search for colleagues with whom they can share information about safety. On the other hand, workers with high levels of safety support skills tend to be considered as reference points in terms of safety by colleagues, who are more prone to look for their help. Implications for both scientists and practitioners are discussed.

“What’s the evidence?”—Towards more empirical evaluations of the impact of OR interventions in healthcare

Despite an increasing number of papers reporting applications of operational research (OR) to problems in healthcare, there remains little empirical evidence of OR improving healthcare delivery in practice. Without such evidence it is harder both to justify the usefulness of OR to a healthcare audience and to learn and continuously improve our approaches. To progress, we need to build the evidence-base on whether and how OR improves healthcare delivery through careful empirical evaluation. This position paper reviews evaluation standards in healthcare improvement research and dispels some common myths about evaluation. It highlights the current lack of robust evaluation of healthcare OR and makes the case for addressing this. It then proposes possible ways for building better empirical evaluations of OR interventions in healthcare.

Model-Informed Precision Dosing: Background, Requirements, Validation, Implementation, and Forward Trajectory of Individualizing Drug Therapy

Model-informed precision dosing (MIPD) has become synonymous with modern approaches for individualizing drug therapy, in which the characteristics of each patient are considered as opposed to applying a one-size-fits-all alternative. This review provides a brief account of the current knowledge, practices, and opinions on MIPD while defining an achievable vision for MIPD in clinical care based on available evidence. We begin with a historical perspective on variability in dose requirements and then discuss technical aspects of MIPD, including the need for clinical decision support tools, practical validation, and implementation of MIPD in health care. We also discuss novel ways to characterize patient variability beyond the common perceptions of genetic control. Finally, we address current debates on MIPD from the perspectives of the new drug development, health economics, and drug regulations.

Non-technical skills in paramedicine: A scoping review

This scoping review aims to identify which non-technical skills have been empirically identified in the literature, to create the first list of empirically identified non-technical skills for paramedics and allied health personnel. A five-stage scoping literature was undertaken in March 2020. The search retrieved a total of 4756 citations. A total of 93 studies met the inclusion criteria and were analyzed for data charting. A total of 26 non-technical skills were identified in the literature. The top five non-technical skills included decision-making (33%, n = 31), communication (24%, n = 23), empathy (17%, n = 16), leadership (12%, n = 12), and ethics (10%, n = 10). Furthermore, only five studies investigated the assessment or measurement of non-technical skills. This scoping review identified 26 non-technical skills that had been investigated in the paramedic literature to create the first list of empirically based desirable non-technical skills for a paramedic. Subsequently, research can then begin to focus on identifying the link that these have to paramedic practice and patient safety.

The use of simulation to prepare and improve responses to infectious disease outbreaks like COVID-19: practical tips and resources from Norway, Denmark, and the UK

In this paper, we describe the potential of simulation to improve hospital responses to the COVID-19 crisis. We provide tools which can be used to analyse the current needs of the situation, explain how simulation can help to improve responses to the crisis, what the key issues are with integrating simulation into organisations, and what to focus on when conducting simulations. We provide an overview of helpful resources and a collection of scenarios and support for centre-based and in situ simulations.

Modelling hospital operations: insight from using data from paper registries in the obstetrics ward at a hospital in Addis Ababa, Ethiopia

In the Ethiopian health system, operations management techniques have been underutilised. Although previous research has outlined limitations of paper-based patient records, few studies have examined their potential utility for improving management of hospital operations. In this paper, we used data collected from paper registries in an Ethiopian obstetrics ward at Addis Ababa’s Tikur Anbessa Specialized Hospital, Ethiopia’s largest university hospital, to model the ward’s operations. First, we attempted to identify predictors of lengthy stays and readmissions among women giving birth: few predictors were deemed significant. Second, time series methods for demand forecasting were applied to the data and evaluated with several error metrics, and these forecasts were improvements over baseline methods. We conclude with recommendations on how the obstetrics ward could incorporate our modelling approaches into their daily operations.

Correction to: A systematic literature review of simulation models for non-technical skill training in healthcare logistics

[This corrects the article DOI: 10.1186/s41077-018-0072-7.].

Logistical and structural challenges are the major obstacles for family medicine physicians' ability to administer adult vaccines

PURPOSE

This study was conducted to characterize the vaccination practices and challenges of family medicine physicians in Los Angeles County, California.

METHODS

The Los Angeles Academy of Family Physicians (LA AFP) sent out electronic surveys to all of their active members (N = 1121) between December 2017 and January 2018, and asked them to answer questions about themselves, their practice, their patient population, and their immunization practices and challenges. We then analyzed the results through basic statistical calculations and Pearson's chi-squared tests.

RESULTS

Seventy-four people (6.6%) responded to the survey, and 75% of responders stated that they administer all Advisory Committee on Immunization Practices (ACIP) recommended vaccines. The lowest vaccine administration rates were for the high-dose influenza vaccine, which 66.2% (n = 49) of respondents reported to administer, followed by the meningococcal B vaccine (68.9%; n = 51). The respondents who belonged to practices with more than 11 providers, were part of a large hospital or healthcare system, had electronic medical records (EMRs), and used the California Immunization Registry (CAIR) were more likely to report to vaccinate. The number one responding physician-reported challenge to vaccination was limited time and resources to address patient resistance followed by vaccine cost and lack of infrastructure to store vaccines.

CONCLUSIONS

In this pilot study, structural and logistical challenges appeared to make the biggest impact on adult vaccination for the responding family medicine physicians. Solutions addressing these challenges will help improve the adult immunization rates.