In-Situ Simulation and ‘Systems Testing’

Dr Pamela WintonDr David Rowney

Royal Hospital for Sick Children Edinburgh

• Overview of simulation• In-situ simulation• Our experience• A strategy to engage management...• ‘Systems Testing’

• Group work

Clinical Simulation

• Rapid rise in Clinical Simulation– Technology and Facilities– Litigation and Insurance– Fellowships and Research– Validated for assessment

• ‘Safer Medical Practice: Machines, Manikins and Polo Mints’ CMO England 2008

• ‘A Framework for Technology Enhanced Learning’ DH 2011

Evidence

• MedTeams – Clinical Error reduction from 30% to 4.4%

• PROMPT– Neonatal hypoxic injuries – 50% reduction– Injuries after shoulder dystocia – 70% reduction– Improvements in performance in Cat 1 sections

In-situ Simulation

• In-situ Simulation• Real time, real areas, real challenges• Reveal gaps in the ‘system’– Equipment, process, training

• Simulation and Debrief• Document information– DATIX, Risk Register, FMEA Analysis, Report

• Action• Re-Test

Our experience

• RHSC Research Facility• New Clinical Trial – ‘SNIFFLE Study’• High Risk Anaphylaxis• Prospectively test system • Re-test

• In-situ, real time emergency team response

Our experience

• Clinical management• Equipment• Debrief – Still difficulties accessing area

• Some issues resolved, some not• Solutions?• Re-test

Activity

• Work with those around your table and develop a single idea for an in-situ simulation designed to test a workplace system.

• Your group will be asked to present a summary of your idea, sketched out on flipchart paper, to the room

Discuss how you could use simulation for system’s testing in your work place

• What do you want to test?• Why do you want to test this?• How would you set it up?• What resources will you need?• What barriers might you face?• What will you do with the findings?• When would you ‘re-test’?

But we don’t have a fancy manikin!

• Simulation a technique not a technology...

• Expertise of facilitator most important element of effective simulation-based education

• Emergency algorithms, drills

In-situ Systems Testing - Novel applications for Simulation

• Evaluate established work processes and systems• Investigate reported errors, faulty systems and

patient safety concerns• Test new equipment and technologies in real-life

setting prior to patient exposure• Test, modify, adapt and orient healthcare

providers to new processes, services, and facilities before introducing to patients

The challenges of in-situ simulation- Real or imagined?

• Fidelity - highest not always best!• Faculty - worth investing in and key to success• Time - compromise might need to be met• Staff not engaging - high face & content validity

means this is the exception rather than the rule• Cost - link with patient safety initiatives,

engage with management, report findings!

Thank you!

A framework for the measurement and monitoring of safety

Source: Vincent C, Burnett S, Carthey J. The measurement and monitoring of safety. The Health Foundation, 2013.www.health.org.uk/publications/the-measurement-and-monitoring-of-safety