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0052 Simulation: Identifying problems and finding solutions
  1. Nicola Jakeman,
  2. Nicholas Blundell
  1. Royal United Hospital, Bath, UK


Background Simulation is an established educational tool and its unique role in facilitating interprofessional learning is established. The use of simulation within governance structures to enhance patient safety is growing. This abstract describes an in situ safety focussed simulation program within the Emergency department at the Royal United Hospital, Bath.

Methods Opportunities to improve patient care are identified through incident reporting, M+M and clinical governance meetings and informal feedback from medical and nursing staff. Processes, procedures and equipment which might benefit from stress testing in a simulated environment are also identified. Scenarios are then designed to meet the needs identified. Scenarios are run insitu in real time using real teams.

The scenarios are followed by a human factor debrief, then by separate nursing and medical technical debriefs. Learning needs and improvements in equipment, ergonomics, processes and procedures are identified. Immediate actions are disseminated through weekly Team Brief and through departmental teaching programs. Actions and recommendations requiring further discussion are fed back into the ED clinical governance meeting. The minutes from these meetings are reported to Divisional and Trust Operational Governance meetings.

Results A range of patient safety/clinical improvements have been identified in addition to a number of learning needs for staff groups. E.g.:

  • Adaptations to the lay out of the paediatric resus trolley

  • Location, use and limitations of the various thermometers in the department.

  • Lack of familiarity with emergency procedures and equipment in the Urgent Care Centre adjacent to ED

Actions have been taken to address a range of safety issues. Any changes will be integrated and tested in future simulations.

Potential impact As this work refines it will become a standard requirement before any new process/piece of equipment or area becomes operational, proactively identifying risk to patients and staff and providing possible solutions.


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  2. Arriaga AF, Bader AM, et al. Simulation-based trial of surgical-crisis checklists. N Engl J Med 2013;368:246–253

  3. Geis GL, Pio B, Pendergrass, et al. Simulation to assess the safety of new healthcare teams and new facilities. Simulat Healthc 2011;6(3):125–133

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