An In Situ Simulation Program: A Quantitative And Qualitative Prospective Study Identifying Latent Safety Threats And Examining Participant Experiences

OBJECTIVE: To explore the impact of in situ simulation training in regard to identification of latent safety threats and participant experiences.

DESIGN: A prospective study including quantitative and qualitative measures.

SETTING: A Danish hospital shifted from simulation training in centers outside the hospital to training where simulation was conducted where the situations normally took place and with the normal working teams.

PARTICIPANTS: A total of 58 local instructors were educated and subsequently conducted in situ simulations in own departments. After each simulation, a log file was completed containing information on location, the scenario, who took part, time, learning points and findings. Furthermore, interviews were conducted with leaders, instructors and simulation participants.

MAIN OUTCOME MEASURES: Identified latent safety threats and participant experiences.

RESULTS: From June 2017 until December 2018, 323 simulations were conducted representing 35 different wards. They consisted of 40 different scenarios and had both technical and non-technical learning goals. A total of 35 organizational issues were uncovered via the in situ simulation and practice was adjusted accordingly. A total of 11 interviews were conducted. Four themes emerged from the analysis: practice-orientation, endorsement, sense of security and additional impact.

CONCLUSION: Transferring simulation to in situ training resulted in a substantial number of organizational findings. The subsequent follow-up and changes in practice made awareness of what could be latent safety threats. Leaders, instructors and simulation participants experienced in situ simulation as relevant and profitable.