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Improving System Safety through Simulations

“Healthcare takes place within an incredibly complex system, and we can only improve patient safety if we improve system safety,” said Sarah N. Bowe, MD, EdM, of the San Antonio Uniformed Services Health Education Consortium. She said the best way to do that is through simulations.

“Simulation is a technique that provides a representation of real healthcare environments and events. Using a systems engineering lens, the complexity of the healthcare system can be distilled into component pieces so that practice, learning, evaluation, and testing can take place,” Dr. Bowe said. “Simulations can then be developed at multiple levels of scale, starting as small as an individual practicing a new technical skill or expanding to multidisciplinary, multisite patient scenarios.”

Dr. Bowe was joined by panelists Liana Puscas, MD, of Duke University Medical Center, James Kearney, MD, of the University of Pennsylvania, and Kaalan Johnson, MD, of Seattle Children’s Hospital and Medical Center, as they discussed the role of simulations in their Tuesday Panel Presentation, “Improving Patient Safety with Systems-based Simulation.”

“Simulation can be used to address any need in any situation, even with limited resources,” Dr. Puscas said as she introduced the traits of a focused simulation. The simulation should be localized and directed, allow for direct feedback to the participant, encompass task and skill learning, and be easy to track and measure. She said you must identify your audience and define your goals—who is going to teach, how are they going to teach it, what do you have already, what do you need, and how are you going to measure the outcomes and show that it was worthwhile?

A powerful immersive learning tool that can drive an organization to improve patient safety is the in situ simulation.

“By bringing simulation into a clinical environment, we can use interprofessional teams to train together,” Dr. Kearney said.

He said to get started in building an in situ simulation program, try to get lined up with other people in your organization already doing simulations. Choose a goal, preferably one that aligns with organizational goals so you get buy-in. Then figure out the logistics—who will be involved, what equipment and systems will be involved, where you will do it, when is the best time to hold it, and how you are going to pull it all together.

Dr. Kearney said there are challenges involved in putting together an in situ simulation. It is time-intensive to plan and to run, and you might have to cancel or reschedule it at the last minute if something else comes up. But the rewards can far outweigh the challenges.

Dr. Johnson said the in situ simulation can be used for institutional process improvement. He detailed two experiences he had in two different hospitals where a real-life situation prompted departments to develop in situ simulations. He said analysis of the experience showed that practitioners found the simulations useful, with 75 percent indicating that, based on what they did during the simulation, they would do something different the next time the situation occurred.

He had many pearls to share, including:

  • Engage your key stakeholders early.
  • Get together an engaged and invested planning team.
  • Start funding conversations early.
  • Practice and refine the scenario before running the in situ simulation.
  • Plan for quality improvement, research, and expansion.
  • Most important, make it fun from start to finish.

Following the presentations, the panelists split up with audience members to have small-group question and answer discussions, where attendees were able to ask detailed questions and discuss their own experiences with simulations.