In Situ Simulation to Detect and Prevent Near Misses during Critical Events

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DESCRIPTION (provided by the applicant): The specific aims of this study are to test the effectiveness of an in situ simulation strategy in a perinatal unit to identify the number of "near misses" for emergent C-sections, examine the reliability of in situ simulation assessment to predict performance, examine the effect of in situ simulation training to criterion level on reducing "near misses," and examine the effect of in situ simulation training on culture of safety and selected patient safety measures. We will use our previously tested in situ simulation protocol employing crew resource management (CRM) training techniques to achieve high reliability performance at the micro-system level. We will assess both human performance and organizational processes with the in situ simulation. In situ simulation is a high-fidelity team-based simulation strategy that occurs on a patient care unit rather than in a simulation laboratory. The in situ simulation strategy consists of separate phases on the perinatal units at two different hospitals - Fairview Southdale Hospital (a community hospital with a medical staff) and the University of Minnesota Hospital-Fairview (an academic hospital with a medical school teaching staff). Our in situ simulation program creates obstetrical emergencies based on emergencies abstracted from real sentinel events. Our intervention to improve patient safety is based on an advanced set of event sets and debriefing techniques in use by the Federal Aviation Agency (FAA).