We present our experience of running a weekly in-situ sim programme in our two busy type 1 ED’s over the last 12 months.
The aim of the programme was to enhance clinical and non-technical skills of our workforce and assess our system processes. The efficacy, feasibility and acceptability of in-situ simulation is well known,1,2 as is its effectiveness at reviewing patient safety issues,3 improving confidence, clinical and non-technical skills4 and fostering teamwork.5
Each simulation runs in real time utilising standard clinical staff and environment. Human simulated or high-fidelity simulated patients are treated like any other patient with staff expected to conduct bedside tests and interventions and prescribe and administer drugs as usual. Post scenario we conduct a detailed, multi-disciplinary, debrief to enrich learning and allow individual and team reflection. Scenarios reflect the departmental case mix and test skills against the Royal College of Emergency Medicine clinical and non-technical skills curriculum.
The scenarios are facilitated by an ED Consultant and Simulation Fellow who also run the debrief, collate feedback and aid with reflection. System errors identified are further tested and remedial measures put in place after governance review.
Participant enthusiasm for the project has grown over the first six months and it is now recognised by our management team as an essential part of our culture. The faculty is set to be enhanced with specific nursing staff investment; project expansion to deliver monthly multi-specialty sessions involving trauma and critical care is in progress.
Each week we produce an editorial (‘Sim News’) which summarises scenario, debrief and learning outcomes -- we disseminate this amongst our department and to the FOAMED community via social media.
We demonstrate the practicality and success of a multi-professional simulation program. We have improved departmental learning, developed a shared commitment to professional development, leading to enhanced patient safety.
Fent G, Blythe J, Farooq O, Purva M. In situ simulation as a tool for patient safety: a systematic review identifying how it is used and its effectiveness. BMJ STEL 2015;1:103–110.
Rosen MA, Hunt EA, Pronovost PJ, et al. In situ simulation in continuing education for the health care professions: a systematic review. J Contin Educ Health Prof 2012;32:243–54.
Patterson MD, Geis GL, Falcone RA, et al. In situ simulation: detection of safety threats and teamwork training in a high risk emergency department. BMJ Qual Saf 2013;22:468–77.
Walker ST, Sevdalis N, McKay A, et al. Unannounced in situ simulations: integrating training and clinical practice. BMJ Qual Saf 2013;22:453–8.
Innocenti F, Angeli E, Alesi A, et al. Teamwork evaluation during emergency medicine residents' high-fidelity. BMJ STEL 2016;2:12–18.
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