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In-situ simulation-based intervention for enhancing teamwork in the emergency department


Simulation-based learning activities in the emergency department (ED) improve communication and teamwork and familiarise personnel with existing protocols. The authors’ objective was to develop standardised in-situ simulations and to assess their effects on team performance during simulated patient care. The study was a prospective, single-centre pre-in-situ and post-in-situ simulation-based intervention in the ED of an academic hospital between March 2017 and February 2018. Teams of three to five participants (n=46) were in two simulation interventions 2 weeks apart; each simulation was followed by debriefing with good judgement. The adapted Simulation Team Assessment Tool (STAT) Score was the primary measure for team performance. Skills are measured on a scale of 2–0 based on the complete and timely performance of tasks for a total (adapted) score of 171. Overall STAT scores improved significantly between simulations I (60.5 (28.3)) and II (81.1 (24.6)), p=029; notably in airway and teamwork domains, p=022 and p=023, respectively. A sub-analysis showed that participants performed significantly better when treating adult versus paediatric simulated patients (87.9 (20.1)), p=003, particularly in teamwork, p=01. The study yielded statistically significant improvement in clinical management, teamwork and resource management skills among ED personnel.

  • simulation-based medical education
  • in-situ simulation
  • simulation for teamwork training
  • simZones
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  • Contributors RS-C and NB contributed to the conception and design of the work, the acquisition of data and critical revision of the submitted report. ZL contributed to the design of the work, the acquisition, analysis and interpretation of the data, as well as drafting, revising and submitting the report. HT revised the analysis and interpretation of the data, as well as the submitted report. RF contributed to the design of the work and the revision of this report. All authors agree to the final version of the submitted report and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The study was supported by institutional funding from AUB. The funding body played no role throughout the study, neither in design, nor implementation, conduct, analysis and preparation of the manuscript.

  • Competing interests None declared.

  • Ethics approval The study was reviewed by the Institutional Review Board of the American University of Beirut and approved as a quality improvement educational intervention.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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