Using Team Simulation to Improve Error Disclosure to Patients and Safety Culture

描述(申请人提供)：透明度是积极的患者安全文化的基石。然而，有害的错误往往没有向患者披露，降低了满意度，损害了医疗质量。重要的披露障碍包括医护人员缺乏事先培训，以及对医护团队在披露中的作用考虑不足。在发生错误后，医护人员团队必须就一些棘手的问题达成共识，例如该事件是否为错误、责任和责任，以及是否披露该事件。我们之前发表的经验表明，使用标准化患者进行模拟是培训医护人员更有效地彼此沟通以及与出错患者进行沟通的理想方式。因此，我们提出了一个具有以下具体目标的前/后模拟项目：1)确定基于团队的模拟培训是否提高了医护人员的知识、态度和技能 向患者披露有害的错误；2)确定基于团队的模拟培训是否有所改善 医护人员关于团队沟通的知识、态度和技能；3)确定教练是否比参与者在基于团队的披露对话中表现出更好的知识、态度和技能。参与者代表不同的执业环境，包括70名医生和护士，以及来自华盛顿大学4家医院和一家大型健康维护组织的12名披露教练。模拟包括团队对两个有害错误的案例做出反应：1)讨论事件、责任和指责，错误发生的原因，以及如何防止复发；2)计划是否以及如何向患者披露事件；3)向标准化患者披露错误。披露教练将帮助团队讨论错误、计划披露并提供反馈。为了增强临床的现实主义，“标准化团队成员”(训练有素的演员)将确保团队面对关键挑战，如讨论责任和解决冲突。主要结果是对模拟对医护人员团队沟通和披露知识、态度和技能的影响进行事前/事后分析，通过基于网络的评估来衡量。改进团队沟通和对有害错误的披露可以提高透明度和安全文化，提高患者满意度，最终促进患者安全。

DESCRIPTION (PROVIDED BY APPLICANT): Transparency is the cornerstone of a positive patient safety culture. Yet harmful errors are frequently not disclosed to patients, diminishing satisfaction and impairing healthcare quality. Important disclosure barriers include healthcare workers' lack of prior training as well as insufficient consideration of healthcare teams' role in disclosure. Following errors, teams of healthcare workers must reach consensus on difficult issues such as whether the event was an error, blame and responsibility, and whether to disclose the event. Our prior published experience suggests that simulation using standardized patients is an ideal modality for training healthcare workers to communicate more effectively with each other and with patients following errors. Therefore, we propose a pre/post simulation project with the following specific aims: 1) To determine whether team-based simulation training enhances healthcare workers' knowledge, attitudes, and skills in disclosing harmful errors to patients; 2) To determine whether team-based simulation training improves healthcare workers' knowledge, attitudes, and skills about team-communication; 3) To determine whether coaches demonstrate enhanced knowledge, attitudes, and skills compared to participants around team-based disclosure conversations. Participants represent diverse practice settings, and include 70 physicians and nurses, and 12 disclosure coaches from 4 University of Washington hospitals and a large health maintenance organization. The simulation involves teams responding to two cases of harmful errors by: 1) discussing the event, responsibility and blame, why the error happened, and how recurrences will be prevented; 2) planning whether and how to disclose the event to the patient; 3) disclosing the error to a standardized patient. A disclosure coach will help the teams discuss the error, plan the disclosure, and provide feedback. To enhance the clinical realism, a "standardized team member" (trained actor) will ensure teams confront key challenges such as discussing blame and resolving conflicts. The primary outcome is a pre/post analysis of the simulations' impact on healthcare workers' team communication and disclosure knowledge, attitudes, and skills as measured by a web-based assessment. Improving team communication and disclosure following harmful errors can enhance transparency and safety culture, increase patient satisfaction, and ultimately promote patient safety.