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0108 Effecting organisational changes following in-situ simulations in mental health hospitals
  1. Christina Tritschler,
  2. Christopher Kowalski,
  3. Rosy Minster
  1. Maudsley Simulation, South London and Maudsley NHS Foundation Trust, London, UK


Background In South London and Maudsley NHS Foundation Trust, an interprofessional emergency response team (ERT) is on duty to respond to emergencies. Whilst human factors play an important role in determining this team’s performance, organisational and systemic factors also have a significant impact on outcome. Simulation-based team training (SBTT) can improve team functioning and performance. Unless this happens in-situ, organisational failures cannot adequately be highlighted and addressed.

An in-situ SBTT course was developed in order to directly assess organisational factors impinging on team performance. Subsequent action was taken to address these.

Methodology The ERT was called out to respond to a simulated medical emergency (cardiac arrest) on five occasions over four hospital sites. As well as assessing team performance, we evaluated the organisational and systemic factors that impacted on this performance. These included: equipment availability and functioning, call out systems, environmental access and local emergency response policies.

Results Factors that were highlighted as problematic included: missing and malfunctioning equipment, inadequate systems for coordinating the emergency response, bleep system malfunctions and environmental access problems. This information was then addressed at service delivery, managerial and directorate level by: liaising with the patient safety advisory team; making recommendations which contributed to the development of local policy; sharing good practice from other sites and subsequent site visits to ensure changes had been made.

Conclusions Our findings demonstrate that in-situ SBTT is an effective means of highlighting organisational factors that impede the successful management of medical emergencies in mental health units. The application of this particular intervention in the field of mental health is a new one. In-situ training requires various logistical difficulties to be overcome. Similarly, improving existing systems can be difficult where organisations are resistant to change. Where these issues can be surmounted, the benefits to patient safety are significant.


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  2. Patterson MD, Blike GT, Nadkarni VM. In situ simulation: challenges and results. In: Henriksen K, Battles JB, Keyes MA, Grady ML, eds. Advances in patient safety: new directions and alternative approaches, 2008

  3. Rosen MA, Hunt EA, Pronovost PJ, Federowicz MA, Weaver SJ. In situ simulation in continuing education for the health care professions: a systematic review. J Contin Educ Health Prof. 2012;32(4):243–254

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