In-Situ Simulation and

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In-Situ Simulation and Systems Testing

• Dr Pamela Winton
• Dr David Rowney
• Royal Hospital for Sick Children Edinburgh

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

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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

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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

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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

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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

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Our experience

• Clinical management
• Equipment
• Debrief
• Still difficulties accessing area
• Some issues resolved, some not
• Solutions?
• Re-test

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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

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Discuss how you could use simulation for systems
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?

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But we dont have a fancy manikin!

• Simulation a technique not a technology...
• Expertise of facilitator most important element
  of effective simulation-based education
• Emergency algorithms, drills

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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

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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!

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Thank you!
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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/t
he-measurement-and-monitoring-of-safety