International Journal of Healthcare Simulation

Background:

In situ simulation is an emerging tool used to test systems, improve patient safety outcomes and prepare staff working in new clinical environments ^[1,2]. Our department opened a new Paediatric Assessment Unit (PAU) in April 2021, which sees an average of 470 patients each month.

Aim:

The aim of the study was to use simulated learning events (SLEs) to assess the effect of a new environment on performance, interpersonal skills and system-based practice. As part of the wider paediatric improvement plan, the simulation programme has been used to enhance teamwork and implement a change to maximize patient safety.

Method:

Five multi-disciplinary SLEs based on paediatric and neonatal emergencies were held over a month following the opening of the new PAU. The simulations were low fidelity and in situ, using static models and facilitator feedback, and were held in the new PAU. Observations were displayed on tablets using the REALITi simulation app by iSimulate. A ‘description, analysis, application’ diamond debrief was held following each SLE, and feedback was collected via an online questionnaire. Latent strengths and safety errors were identified and shared with the wider working group to implement a change. Safety errors were then re-assessed at subsequent SLEs to demonstrate resolution.

Results:

Ten latent errors were identified pertaining to the availability of equipment and medications; all were rectified within 2 weeks. Operational errors were also identified, including unfamiliarity with the new PAU location within the wider emergency team, leading to delayed attendance to the simulation. The time taken to attend the PAU by the anaesthetic team decreased by 69% once the emergency bleep message was amended with location instructions. We observed that, with each SLE, there were successive improvements in teamwork and operational behaviours. The teams were able to familiarize themselves with each other and the new working environment, consequently leading to reduced times on acquiring equipment for the emergency. There were a total of 20 participants from paediatric, anaesthetic and nursing backgrounds. Feedback was received from 55% of participants, of which all agreed or strongly agreed that the SLEs and debriefs contributed to their learning and helped develop their team-working and leadership skills.

Implications for practice:

SLE is an effective tool for systems testing in a new clinical environment and helps to identify potential critical and non-critical safety risks. We will continue to develop our simulation programme to assess a variety of clinical environments and share learning from the latent strengths and errors with the multi-disciplinary team, to improve clinical processes, team working and patient safety outcomes.