Healthcare is one of the most high-acuity, highly scrutinized industries in today’s world in terms of what is at stake. For those who manage risk, this implies the need for constant vigilance and continuous improvement. While some degree of risk may be inevitable in healthcare, new tools exist to identify and predict when and where it will occur—on a micro scale. And, it’s possible to reduce the negative impact that risk can have on patient outcomes as well as financial matters.
The patient safety movement that started two decades ago has led to growing interest in using simulation to reduce risk and improve patient safety. Simulation-based training – as a teaching strategy and not just referring to the technology itself – is often praised for its ability to replicate the reality of the patient journey. Likewise, simulation can be used as a means to measure, assess, prevent, and minimize risk to hospitals.
Other high-risk industries such as aerospace, transportation, and power-generation have become steadily safer with the aid of simulation.1 In hospitals, in addition to providing standardized, repeatable clinical training, we’ve learned from our clients’ experience that when a simulation culture is adopted, they see the following improvements:
- Reduced sentinel events
- Reduced litigation expenses
- Improved patient satisfaction scores
- Improved insurance rates
- Improved patient outcomes
Below, we dive into five specific ways simulation can make a difference. Each provides a reason why it is worth considering as a means of mitigating risk in your organization.
1. Identifying Latent Risk
Latent safety threats (LSTs), or the errors in design, organization, training, or maintenance of the healthcare facility, can contribute to negative patient outcomes. These are known as accidents waiting to happen and may be overlooked in routine risk assessments.
In situ simulation, or simulation that occurs within the actual care setting as opposed to in a simulation center, can help to identify LSTs before they cause harm to a patient or provider. Often, in situ simulation involves an interdisciplinary team (just as a real patient case would) and provides the context of the normal workflow.
By allowing a simulation scenario to unfold in the real clinical environment, participants are challenged with the same distractions, resource limitations, obstacles, and system flaws that they work with daily.2 This is precisely how in situ simulation can bring to light potential risks before it is too late.
2. Accounting for Human Factors
Hospital systems are inherently subject to human error. Patient cases can be complex, dynamic, and stressful and, even for the most experienced healthcare professionals this can lead to mistakes. Additionally, throughout the continuum of care, a patient is not only treated by one single provider. Research shows that approximately 70% of deaths caused by medical errors are related to communication breakdowns during handoffs.3 Simulation can be used to improve interpersonal communication skills and teamwork skills, reducing this risk.4
Simulated patient cases offer providers a chance to practice using patient safety tools, such as TeamSTEPPS®, Crew Resource Management, or their own new internal protocols. As these simulations can be standardized, all members of an interdisciplinary team can be trained to conduct teamwork and communication to the organization’s standard. This means that providers who may have never worked together will be able to communicate accurately and efficiently, minimizing the chances of mistakes and misunderstandings.
3. Conducting a Root Cause Analysis
Adverse events, including sentinel events, require comprehensive review and investigation to uncover the cause as well as to prevent the likelihood that the same event will occur again. The root cause analysis and action plan moving forward can be made stronger through simulation.5
Specifically, a simulation of the incident can help to answer these three questions:6
- What happened?
- Why did it happen?
- What can be done to prevent it from happening again?
Simulation scenarios can be designed to repeat the adverse event that took place, using data extracted from the electronic medical records (ERM). And, as the scenario is repeatable, it can be run multiple times to test variables that might affect the outcome. Typically, the root causes identified through simulation tend to focus more on systems-based error rather than errors caused by individuals.7 This information can then improve the implementation of corrective measures and decrease the risk of recurrence.
4. Predictive Modeling
Similar to the ability to replicate an event that already occured, simulation affords an organization the chance to ask ‘what if?’ As predictive analysis is conducted and clinical target areas are prioritized, simulation can provide the ability to test and re-test any combination of theories and solutions. Using a customized scenario, the room design, and hand-selected participants, it is possible to create a controlled environment.
In addition, the right simulation learning management platform will allow for the extraction of pertinent data. Based on previously run simulations, risk managers can access data about provider performance, trends, and areas of the highest risk. This can aid in the reduction of patient harm, provider harm, or the rate of readmission.
5. Improving Care Quality and Patient Satisfaction
HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) results are important to a hospital’s overall success. A low or high score can impact a hospital’s marketability as well as its reimbursement rates. Just as simulation training can improve the ability of providers to communicate effectively with one another, it can also develop a provider’s interpersonal skills with patients.
Using a standardized patient, who can mimic emotional and psychological displays, can reinforce the importance of listening, observing, and communicating. And, this training can be further enhanced with the use of a full-bodied simulator that can receive medical interventions.
Developing a simulation focused on soft-skills can help providers adopt new communication styles, practice providing explanations in laymen terms, and rehearse keeping agitated patients calm. Each of these contribute to increased patient trust and, therefore, more disclosure about their symptoms. Ultimately, this can lead to more accurate diagnoses, better medication adherence, and even higher scoring on the HCAHPS.
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Nursing Anne Simulator
Nursing Anne Simulator is a modular platform consisting of a variety of accessories and interchangeable parts that facilitate a variety of simulated patients and provide unique training opportunities.
SimBaby is a tetherless simulator designed to help healthcare providers effectively recognize and respond to critically ill pediatric patients.
Co-created with the AAP, SimNewB is a newborn tetherless simulator designed to help improve neonatal resuscitation.
Obstetric Solution - SimMom & MamaBirthie
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- Agency for Healthcare Research and Quality. (2018). Healthcare simulation to advance safety. Retrieved from https://www.ahrq.gov/research/findings/factsheets/errors-safety/simulproj15/index.html
- Lamberta, M. & Aghera, A. (2020). Latent safety threat identification via medical simulation. Stat Pearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK549909/
- University of Illinois at Chicago. (2016). Preventing medical communication errors: Study examines multidisciplinary rounding in hospitals. ScienceDaily. Retrieved February 8, 2021 from www.sciencedaily.com/releases/2016/12/161220095204.htm
- Lamberta, M. & Aghera, A. (2020. See reference #2.
- Slakey, D.P., Simms, E.R., Rennie, K.V., Garstka, M.E., Korndorffer, J.R. Jr. (2014). Using simulation to improve root cause analysis of adverse surgical outcomes. International Journal for Quality in Health Care, 26(2), pg. 144-150). Retrieved from https://doi.org/10.1093/intqhc/mzu011
- Ewen, B.M & Bucher, G. (n.d.) Root cause analysis: Responding to a sentinel event. Lippincott Nursing Center. Retrieved from https://www.nursingcenter.com/ce_articleprint?an=00004045-201309000-00006