Board #151 - Research Abstract Training for Time-Outs Prior to Invasive Procedures

Abstract

Hypothesis High-fidelity simulation (HFS) is an effective teaching format for teaching and practicing the Universal Protocol and time-outs prior to invasive procedures. HFS is associated with increased learner confidence in the performance of and improved compliance with time-outs following HFS-based training (Paull et al, 2013). However, HFS does not necessarily scope well for training large numbers of often rapidly rotating Residents performing invasive procedures in a healthcare organization. Virtual patient simulation (VPS) provides an alternative learning format capable of delivering asynchronous education to a nearly limitless number of participants. The purpose of this study was to compare HFS and VPS effectiveness in time-out training using a previously reported and validated thoracentesis simulation scenario. Methods Residents and faculty attending regularly scheduled Patient Safety Workshops were enrolled in either a HFS or an on-line VPS time-out educational experience. The simulation scenario for both HFS and VPS was identical and has been previously described (Paull et al, 2013). There were 107 HFS participants and 111 VPS participants. Following either the HFS or VPS experience, participants completed a Ensuring Correct Surgery and Invasive Procedures (ECS) Post-Questionnaire of their confidence in performing elements of the time-out. The learners’ ability to successfully detect the wrong medical image (wrong- patient, wrong-side pleural effusion) during the HFS or VPS simulation scenario was observed and recorded either using the previously validated ECS Observation Checklist during HFS or via the User Access Summary from the Decision Simulation VPS. Results Post-simulation survey scores for confidence in performing a time-out, marking and confirming the procedure site, identifying the patient using a standardized technique, and reviewing the medical images were similar among HFS and VPS graduates, Table 1 (p not significant, two-tailed, unpaired Student t test). However, there was a large difference in the identification of the wrong patient X-ray. Among 74 HFS observations, there were 9 (12%) failures to identify the wrong chest X-ray compared to 53 failures for the 83 (64%) VPS observations (p < 0.001, two-tailed chi-square). Conclusion The results suggest that VPS may serve as a suitable alternative to HFS for teaching time-outs. However, there are notable differences between the learning that occurs with HFS and VPS. Likely due to the other real-life, engaged team members involved in HFS, individual provider errors (such as a wrong X-ray) are often “caught” leading to a “close call” experience which is then discussed within the face-to-face debriefing. On the other hand, solo learners in VPS often do not catch the wrong X-ray, experience an adverse event, followed by a scripted “debriefing” by a synthetic agent. These potential differences will need to be considered by healthcare simulation educators developing patient safety curricula.