Table 1

Summaries of included studies

Andreatta et al 26 Investigated the role of mock codes in paediatric cardiopulmonary arrest (CPA) survival rates. Mock codes were held monthly at random times during Monday through Friday day shifts, increasing in number as the study progressed. All regular code team members were involved including medical residents, paediatric intensive care unit nurses, medical students, hospitalists and pharmacists. High-fidelity manikins were used in either the clinical simulation centre or a functional paediatric patient room. Scenarios ranged from sepsis, respiratory distress, increased intracranial pressure/herniation, anaphylactic shock and cardiogenic shock. Each code encompassed one or more scenarios with initial emphasis on pulseless rhythms in year 1, followed by rhythms with a pulse in year 2 and a composite in years 3 and 4. Debriefing events led by trained clinical faculty followed the mock codes where video recordings were used. The chosen outcome of interest was survival rates, defined as a patient survival-to-discharge percentage. CPA survival rates increased during the first year and slightly increased again for the last 2 years of the study.
Steinemann et al 27 Examined the effect of a novel 4-hour team training curriculum, consisting of online teaching, multiple in situ simulation exercises and simulation debriefs. Participants consisted of all healthcare professionals involved in an acute resuscitation, including staff physicians, residents, nurses, respiratory therapists and emergency department technicians. Outcomes of interest were primarily skills based; however, this study also evaluated the effect of the simulation-based training curriculum on patient survivability after intervention, reporting a non-significant impact.
Riley et al 28 Investigated the effects of didactic training alone or in combination with in situ simulation on adverse prenatal outcomes. Three hospitals were randomly assigned to either have no intervention (control), TeamSTEPPS didactic training, or in situ simulation integrated with TeamSTEPPS training (full intervention). Participants included all the labour and delivery staff. Eleven in situ simulations were conducted across half a year after didactic training in the third hospital. Outcomes included the Weighted Adverse Outcome Score which decreased in the full-intervention hospital, stayed the same in the didactic-only hospital and increased in the control hospital.
Knight et al 29 Examined the clinical effects of a composite resuscitation team training programme. The training included in situ simulation along with other interventions. The preintervention baseline period was 4 years with an intervention period of 1 year. The study demonstrated an improvement in the primary outcome which was survival-to-discharge following a CPA. Exclusion criteria included events which used extracorporeal membrane oxygenation (ECMO) at code initiation.
Braddock et al 30 Investigated the effect of a multifaceted patient safety programme on clinical outcomes. Baseline measurements were conducted over 1 year followed by a 1-year intervention period and a 6-month sustainability period. The intervention comprised in situ simulation training adjunctive to other interventions. In situ simulations were conducted four times per month during the intervention period and monthly during the sustainability period on both day and night shifts. Scenarios were designed to mimic clinical states preceding acute deterioration where both technical and non-technical skills were emphasised. Measured outcomes included hospital-acquired severe sepsis/septic shock, acute respiratory failure, rate of unplanned transfers to higher level of care (HLOC) and weighted risk adjusted observed to expected mortality ratio. All outcomes except for the rate of unplanned transfers to HLOC improved significantly when compared with both the baseline period and to control hospital units which did not receive the training programme.
Sodhi et al 31 Investigated cardiopulmonary resuscitation outcomes with interventions including mock codes along with other optimisation protocols. The mock codes were conducted at least twice a year in different departments around the hospital. The study demonstrated improvement in the rate of return of spontaneous circulation (ROSC) as well as survival-to-discharge.
Riley et al 32 Analysed the effect of a quality improvement collaborative on prenatal outcomes from 14 hospitals. This initiative included a 2-year baseline followed by a 5-year intervention period which encompassed three primary interventions: a standardised care process, teamwork training through in situ simulation, and education and performance feedback. Phase 1 introduced education and performance feedback as well as a standardised care process over 3 years. It was followed by phase 2 which occurred during the last 2 years of the study and included in situ training. This study demonstrated a decrease in the adverse outcome index after intervention.
Theilen et al 33 Examined the effect of introducing a paediatric medical emergency team (PMET) coupled with weekly in situ simulation training on hospital outcomes. Non-PMET staff, registrars and senior nurses from all hospital wards were also included in this training programme as a hospital-wide initiative. The study demonstrated an insignificant decrease in paediatric intensive care unit (PICU) mortality yet showed a significant decrease in hospital-wide deaths, which was not a predetermined outcome.
Gibbs et al 34 Implemented and investigated the effect of an in situ simulation programme to combat a methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a level 4 neonatal intensive care unit. Physicians, nurses, respiratory therapists and environmental service workers completed the training programme which incorporated 30 min in situ simulations along with debriefing. The main educational principles of interest were proper techniques of personal protective equipment, hand hygiene, handling potentially contaminated materials and entering/existing infected rooms. This study demonstrated a significant decrease in the number of infections.