A novel in situ simulation framework for introduction of a new technology: the 3-Act-3-Debrief model

Lisa T. Barker,Emilie S. Powell,Kimberly L. Cooley,Andrew L. Vincent,William F. Bond,Jeremy S. McGarvey,John A. Vozenilek

doi:10.1186/s41077-020-00145-x

Abstract

BackgroundNew technologies for clinical staff are typically introduced via an “in-service” that focuses on knowledge and technical skill. Successful adoption of new healthcare technologies is influenced by multiple other factors as described by the Consolidated Framework in Implementation Research (CFIR). A simulation-based introduction to new technologies provides opportunity to intentionally address specific factors that influence adoption.MethodsThe new technology proposed for adoption was a telehealth cart that provided direct video communication with electronic intensive care unit (eICU) staff for a rural Emergency Department (ED). A novel 3-Act-3-Debrief in situ simulation structure was created to target predictive constructs from the CFIR and connect debriefing to specific workflows. The structure and content of the simulation in relation to the framework is described. Participants completed surveys pre-simulation/post-simulation to measure change in their readiness to adopt the new technology.ResultsThe scenario was designed and pilot tested before implementation at two rural EDs. There were 60 interprofessional participants across the 2 sites, with 58 pre-simulation and 59 post-simulation surveys completed. The post-simulation mean ratings for each readiness measure (feasibility, quality, resource availability, role clarity, staff receptiveness, and tech usability) increased significantly as a result of the simulation experience.ConclusionsA novel 3-stage simulation-debriefing structure positively targets factors influencing the adoption of new healthcare technologies.

Highlights

Healthcare simulation has served a variety of functions in support of patient safety including latent threat identification [1,2,3] training for high-criticality/low-frequency events [4], and improving teamwork, [5,6,7] invasive procedural safety [8], and critical care skills [9]
Participation A total of 60 clinicians participated in the in situ simulations across both sites
All participants consented to participate in the surveys, which were not required to participate in the education

Summary

Introduction

Healthcare simulation has served a variety of functions in support of patient safety including latent threat identification [1,2,3] training for high-criticality/low-frequency events [4], and improving teamwork, [5,6,7] invasive procedural safety [8], and critical care skills [9]. Given the complexity of change implementation in the healthcare environment, a Consolidated Framework for Implementation Research (CFIR) was proposed in 2009 [18] This framework synthesized available implementation models with a primary focus on health services. The CFIR divides the factors that influence uptake of a new health services intervention into five domains: intervention characteristics, outer setting, inner setting, characteristics of individuals, and implementation process. Each of these domains encompasses multiple constructs. Successful adoption of new healthcare technologies is influenced by multiple other factors as described by the Consolidated Framework in Implementation Research (CFIR).

Methods

Results

Conclusion