Identification of Latent Safety Threats Using High-Fidelity Simulation-Based Training with Multidisciplinary Neonatology Teams
Identification of Latent Safety Threats Using High-Fidelity Simulation-Based Training with Multidisciplinary Neonatology Teams
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DOI：
10.1016/s1553-7250(13)39037-0
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发表时间：
2013-06-01
影响因子：
2.3
通讯作者：
Geis, Gary L.
中科院分区：
文献类型：
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作者：
Wetzel, Elizabeth A.;Lang, Tara R.;Geis, Gary L.
背景资料：潜在安全威胁（LST）是设计、组织、培训或维护方面的错误，可能导致医疗错误并对患者安全产生重大影响。在这篇文章中描述的调查进行了一个更大的前瞻性，纵向评估的一部分，使用实验室和原位模拟为基础的培训课程，以提高技术和非技术技能的新生儿重症监护室（NICU）供应商在三级学术NICU.Methods：模拟进行实验室（每届会议4个场景）和原位（每届会议1个场景）设置与多学科儿科团队。主持人和受试者在每个场景后立即进行标准化汇报时确定LST。入组后，主持人将LST分类为设备、药物、人员、资源或技术技能。普遍存在的团队知识差距进一步细分为缺乏认识或理解，程序执行不正确，遗漏必要的行动，或不适当的action.Results：在19个月的招生期间（2009年8月至2011年3月），177名受试者的202新生儿重症监护室供应商在实验室接受了培训，其中135人参加了原位会议。在实验室中，完成了22次会议，确定了70个LST（每个场景0.8个LST）。在16次现场会议期间，确定了29个LST（每个情景1.8个LST）。99 LST报告给新生儿重症监护室领导，导致19记录improvement.Conclusions：新生儿重症监护室设置有一个以前未识别的LST的高利率。进行现场情景允许识别在模拟实验室中未检测到的新型LST。随后对实际临床护理环境所做的临床改进是基于模拟的多学科团队培训益处的最佳客观证据。
Background: Latent safety threats (LSTs) are errors in design, organization, training, or maintenance that may contribute to medical errors and have a significant impact on patient safety. The investigation described in this article was conducted as part of a larger prospective, longitudinal evaluation using laboratory- and in situ simulation-based training sessions to improve technical and nontechnical skills of neonatal ICU (NICU) providers at a Level III academic NICU.Methods: Simulations were performed in laboratory (4 scenarios per session) and in situ (1 scenario per session) settings with multidisciplinary neonatology teams. Facilitators and subjects identified LSTs during standardized debriefings immediately following each scenario After enrollment, facilitators classified LSTs into equipment, medication, personnel, resource, or technical skill. Pervasive team knowledge gaps were further subclassified into lack of awareness or understanding, procedure performed incorrectly, omission of necessary action, or inappropriate action.Results: In a 19-month period of enrollment (August 2009-March 2011), 177 subjects of 202 NICU providers were trained in the laboratory, 135 of whom participated in the in situ sessions. In the laboratory, 22 sessions were completed, with 70 LSTs identified (0.8 LSTs per scenario). During the 16 in situ sessions, 29 LSTs (1.8 LSTs per scenario) were identified. The 99 LSTs were reported to NICU leadership, leading to 19 documented improvements.Conclusions: The NICU setting has a high rate of previously unidentified LSTs. Conducting in situ scenarios allows for the identification of novel LSTs not detected in the simulation laboratory. The subsequent clinical improvements made to the actual clinical care environment are the best objective evidence of the benefits of simulation-based multidisciplinary team training.