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

描述（申请人提供）：本研究的具体目的是在围产期单位测试原位模拟策略的有效性，以确定紧急剖腹产的“未遂”数量，检查原位模拟评估的可靠性，以预测性能，检查原位模拟培训的效果，以减少标准水平的“未遂”，“并研究现场模拟训练对安全文化及选定病人安全措施的影响。 我们将使用我们以前测试过的现场模拟协议，采用机组资源管理（CRM）培训技术，以实现高可靠性性能的微系统级。我们将通过现场模拟评估人员绩效和组织流程。 现场模拟是一种高保真的基于团队的模拟策略，发生在病人监护病房，而不是在模拟实验室。现场模拟战略包括两个不同医院围产期病房的不同阶段- Fairview Southdale医院（一家有医务人员的社区医院）和明尼苏达大学Fairview医院（一家有医学院教学人员的学术医院）。我们的现场模拟程序根据从真实的哨兵事件中提取的紧急情况创建产科紧急情况。我们改善患者安全的干预措施是基于联邦航空局（FAA）使用的一套先进的事件集和汇报技术。

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).