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Web site spotlight: Create a culture of safety with simulation training

Staff Development Weekly: Insight on Evidence-Based Practice in Education, April 10, 2009

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Many hospitals and medical schools offer some variation of simulation-based training in which nursing and medical students learn clinical techniques by using lifelike mannequins. This strategy helps clinicians develop their skills before treating actual patients and some hospitals are taking things to the next level by tying simulation to a newer concept: a culture of safety.

The Agency for Healthcare Research and Quality (AHRQ) is currently funding research studies to determine how simulation training affects patient safety. Among them is a study run by David Gaba, MD, associate dean for immersive and simulation-based learning at Stanford (CA) University and director of the Patient Simulation Center of Innovation at VA Palo Alto Health Care System.

Gaba’s team conducted a baseline safety culture assessment in three diverse hospitals: a large tertiary care academic hospital, a medium-size suburban hospital, and a 25-bed rural critical access hospital. His team developed three 2.5-day simulation training programs, one for each hospital. The study is ongoing, but Gaba says the training is working.

“No matter how small a hospital is, it’s possible for them to do very useful and beneficial simulation training,” he says. “A lot of people think it’s only for the big academic hospital, and really, that isn’t true.”

Simulation, he says, takes many forms: verbal, paper to pencil, standardized patient actors, on-screen simulators, virtual worlds that mimic online video games, surgical and procedural task trainers to practice suturing and other technical skills, team simulation, mannequin simulation in a full simulated clinical environment, or simulation in working hospital areas.

“We give them challenging clinical situations to deal with that address important issues in patient safety. Whether that is done with people in a single discipline or multidiscipline, usually you are addressing import-ant aspects of teamwork,” says Gaba.

A lot of the simulation focuses on ICU crises, such as cardiac arrest, sepsis, and anaphylaxis. Gaba says these are common simulation focuses because clinicians don’t always get the chance to work on these events while in the hospital, and the clinical and teamwork procedures in the stressful environment are complicated.

Editor’s note: This excerpt was adapted from “Use simulation training to boost your facility’s culture of safety” found in the Reading Room at www.StrategiesForNurseManagers.com. Get a free trial membership that will give you 30 days to test drive all the exciting features on the Web site.

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