Enhancing Patient Safety through Simulation Teaching: Impact and Effectiveness

1. Simulation Teaching & Patient Safety Owain Leng Simulation Fellow University Hospital of North Tees

2. What do we mean by simulation teaching? • Why is simulation teaching effective? • How can simulation teaching impact on patient safety?

3. Simulation • “Simulation is a technique—not a technology—to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner.” DM Gaba. QualSaf Health Care 2004;13:i2-i10

5. High-Fidelity Simulation • Teamwork • Communication • Situational Awareness • Prioritisation • Complex decision making

7. Debriefing:Simulation is just an excuse to Debrief “The purposeful structured period of reflection, discussion and feedback undertaken by learners” B Flanagan, Manual of Simulation in Healthcare, p.155

8. Rudolph et al. Debriefing as formative assessment: closing performance gaps in medical education. Academic Emergency Medicine 2008; 15(11)pp.1010-16

10. ‘The vast majority of NHS • care is safe, but mistakes • do happen, sometimes • with tragic consequences. • We can only prevent these • problems if we learn from • what goes wrong’

11. How can Simulation Help?The North Tees experience Learning Needs Simulation Intervention

13. 52 BG: Asthma, Anxiety, Schizophrenia ABG PaCO2 = 5.9 kPa

14. Case went to SUI Panel – identified key contributors to error • Mistaken attribution of symptoms to mental health issues • Failure in interpretation of Arterial Blood Gas result • Failure in escalation escalate for senior advice

17. Can we change practice? • 100% of Foundation Doctors surveyed 4 weeks later reported that they had made a change to their practice as a result of the simulation teaching. • Emerging evidence base demonstrating that simulation-based educational interventions can change practice

18. This session was very useful – I learnt a lot through doing the simulation and by watching the other group and discussing Running through the scenarios in a systematic way was really useful Succinct – told me what I need to improve on (fluency, phone calls) with constructive feedback I am more mindful of prognostic scores and how to interpret them I feel much more confident to manage cases like this now More aware of the need to prioritise these patients

19. Advantages Disadvantages • Faculty Intensive • Time-consuming • Challenge to deliver to large target audiences • Expensive Human Factors focus Debrief / Feedback Organisational memory Address system issues Reveal latent safety threats Exposure to high risk low frequency events Accelerates the expertise curve practise without risk

20. Would simulation work for you? • Consider the errors that occur in your work-place • Are they most often simple knowledge-based errors? • Or are they more often complex, multi-factorial errors with underlying Human Factor components?

21. Thank you QUESTIONS?

24. Training targeted as specific groups • In-situ training in targeted areas • Accessible optional training opportunities