Oral Themed Presentation
How a Mock Code Writing Assignment Evolved into a Robust In-situ Simulation Program in a Small Community Hospital
1. Discuss the simulation challenges in small, community hospitals
2. Identify the key components of an effective in-situ simulation-based educational experience
3. Create a plan for initiating an in-situ simulation-based educational experience in home institution
Simulation is an effective strategy for health professions education. The literature is replete with studies highlighting the benefits of simulation-based education, but often these initiatives take place in well-equipped, academic-based settings or in hospitals with strong academic affiliations. Data on simulation-based education is lacking from smaller, community-based hospital settings that may not have the same resources as their larger counterparts. Small, community hospitals often have limitations in providing robust simulation education. There is a need to explore the development and implementation of simulation-based education in community hospitals, and the unique challenges of such initiatives. This presentation will focus on the evolution and integration of a pediatric in-situ simulation program at a 464-bed community hospital.
The hospital obtained funding for and built a small simulation lab in 2009. The pediatric physicians immediately saw the benefits of simulation and became avid users, although they lacked any formal training in simulation design and methodology. By 2014, the writing and running of a mock code became a fixture in the residents’ education. In 2017, a full time Director of Simulation was recruited and in conjunction with the Pediatric staff began plans to use the mock code writing requirement as a platform for developing a standardized in-situ simulation (ISS) program incorporating evidence based best practices.
ISS gives participants the opportunity to have an authentic learning experience and allows for an opportunity to evaluate systems and identify conditions that increase the vulnerability to adverse events. Systems failures within healthcare settings invariably lead to poor patient outcomes. ISS is an ideal method of identifying system issues, and such information can be beneficial for implementing procedural and system changes.
ISS gives practitioners the opportunity to not only exam medical management and technical skills, it also allows for real-time exploration of communication and team skills. The default position when errors occur is to assume the adverse event happened because of knowledge or skills deficits. In reality, they constitute only 30% of all errors. Most of the errors resulting in poor patient outcomes can be attributed to some form of communication breakdown among healthcare team members. Post ISS team debriefings allow team members to reflect on participant performance and to identify strategies for improving future performance.
This presentation will discuss the challenges of, and the strategies needed to implement a pediatric in-situ simulation program in a small, community hospital. Established evidence-based best practices for ISS and simulation curriculum design will be presented. The overarching goal is to provide the audience with the tools to develop an ISS program and the confidence to begin implementation.