Emergency Simulation Training Research Articles

High-Fidelity Hybrid Simulation of Allergic Emergencies Demonstrates Improved Preparedness for Office Emergencies in Pediatric Allergy Clinics

Simulation models that used high-fidelity mannequins have shown promise in medical education, particularly for cases in which the event is uncommon. Allergy physicians encounter emergencies in their offices, and these can be the source of much trepidation. To determine if case-based simulations with high-fidelity mannequins are effective in teaching and retention of emergency management team skills. Allergy clinics were invited to Arkansas Children's Hospital Pediatric Understanding and Learning through Simulation Education center for a 1-day workshop to evaluate skills concerning the management of allergic emergencies. A Clinical Emergency Preparedness Team Performance Evaluation was developed to evaluate the competence of teams in several areas: leadership and/or role clarity, closed-loop communication, team support, situational awareness, and scenario-specific skills. Four cases, which focus on common allergic emergencies, were simulated by using high-fidelity mannequins and standardized patients. Teams were evaluated by multiple reviewers by using video recording and standardized scoring. Ten to 12 months after initial training, an unannounced in situ case was performed to determine retention of the skills training. Clinics showed significant improvements for role clarity, teamwork, situational awareness, and scenario-specific skills during the 1-day workshop (all P < .003). Follow-up in situ scenarios 10-12 months later demonstrated retention of skills training at both clinics (all P ≤ .004). Clinical Emergency Preparedness Team Performance Evaluation scores demonstrated improved team management skills with simulation training in office emergencies. Significant recall of team emergency management skills was demonstrated months after the initial training.

Emergency obstetric simulation training: How do we know where we are going, if we don't know where we have been?

Obstetric emergencies contribute significantly to maternal morbidity and mortality. Current training in the management of obstetric emergencies in Australia and internationally focusses on utilising a multidisciplinary simulation-based model. Arguments for and against this type of training exist, using both economic and clinical reasoning. To identify the evidence base for the clinical impact of simulation training in obstetric emergencies and to address some of the concerns regarding appropriate delivery of obstetric emergency training in the Australian setting. A literature search was performed to identify research undertaken in the area of obstetric emergency training. The initial literature search using broad search terms identified 887 articles which were then reviewed and considered for inclusion if they provided original research with a specific emphasis on the impact of training on clinical outcomes. Ninety-two articles were identified, comprising evidence in the following clinical situations: eclampsia, shoulder dystocia, postpartum haemorrhage, maternal collapse, cord prolapse and teamwork training. Evidence exists for a benefit in knowledge or skills gained from simulation training and for the benefit of training in small units without access to high-fidelity equipment or facilities. Evidence exists for a positive impact of training in obstetric emergencies, although the majority of the available evidence applies to evaluation at the level of participants' confidence, knowledge or skills rather than at the level of impact on clinical outcomes. The model of simulation-based training is an appropriate one for the Australian setting and should be further utilised in rural and remote settings.

Learning from NAP 4: multidisciplinary simulation training in airway emergencies

Learning from NAP 4: multidisciplinary simulation training in airway emergencies

Hybrid Simulations Using Standardized Patients and High Fidelity Mannequins for Anaphylaxis and Asthma Treatments in an Office Setting

OPEN ACCESSSeptember 24, 2012Hybrid Simulations Using Standardized Patients and High Fidelity Mannequins for Anaphylaxis and Asthma Treatments in an Office Setting Joshua Kennedy, MD, Travis Hill, Grace Gephardt, MEd, Mary Cantrell, MA, Tonya Thompson, MD Joshua Kennedy, MD University of Virginia School of Medicine Google Scholar More articles by this author , Travis Hill Arkansas Children's Hospital Google Scholar More articles by this author , Grace Gephardt, MEd Arkansas Children's Hospital Google Scholar More articles by this author , Mary Cantrell, MA Arkansas Children's Hospital Google Scholar More articles by this author , Tonya Thompson, MD Arkansas Children's Hospital Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9239 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstract Introduction: In-office medical emergencies can be a source of trepidation for both medical and administrative personnel. Lack of preparation, equipment, training, and communication amongst staff are cited as the most frequent reasons for suboptimal patient care in an office emergency in a general pediatric or family practice clinic. This resource utilizes hybrid simulations using standardized patients and high-fidelity mannequins for anaphylaxis and asthma treatments in an office setting to teach medical students, nurses, residents, and physicians (learners) the importance of prompt treatment of allergic emergencies. Methods: Within this resource, we provide three case presentations of patients requiring emergent treatment for allergic emergencies. These cases are considered hybrid scenarios because they require the use of both standardized patients with high-fidelity mannequins. Each simulation has a separate script required to introduce the case. We have also provided a flow diagram for the scenarios that will allow staff members who are responsible for real-time changes in the simulations to make adjustments in the outcomes of these simulations dependent upon learner input. Results: We have utilized these simulations in a research study performed at the University of Arkansas Children's Hospital. Participant scores demonstrated improved team management skills with simulation training in office emergencies. Because the true outcome of interest in office emergencies is the outcome of resuscitations, we cannot determine whether utilizing these simulations improved emergency care to actual patients. Discussion: Upon seeing the mannequin, some of the learners did not take the scenario seriously, perhaps taking longer than they would to perform an actual emergency resuscitation. We attempted to improve this outcome by stressing the importance of participant buy-in. In postworkshop feedback from learners, subjects felt as if they were responding to a true emergency if the scenario was thrust upon them during other instruction due to its unexpected nature. Educational Objectives By the end of this resource, learners will be able to: Prepare for in-office allergic emergencies involving severe anaphylactic reactions in an organized and safe fashion.Understand the treatment of anaphylaxis and asthma and the importance of immediate interventions.Obtain a history promptly and accurately from standardized patients and apply this knowledge to formulate differential diagnoses and correct interventions on a mannequin.Establish an effective leader that is able to delegate responsibilities to other members of the team.Provide members of the team with particular roles in the care and treatment of the patient and their family and ensure that these members stay on task throughout the emergency.Communicate effectively using a closed-loop communication model, which includes repeating orders and informing when particular orders are completed. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Asthma CEPTE evaluation.doc Asthma Scenario Flow sheet.doc GI Anaphylaxis CEPTE evaluation.doc Hybrid Simulations for Anaphylaxis and Asthma Treatments.doc Medication dosages.docx Peanut Anaphylaxis CEPTE evaluation.doc Peanut and GI Anaphylaxis scenario Flow sheet.doc Post Course Evaluation.doc To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2012 Kennedy et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsEpinephrineAnaphylaxisIn-Office EmergenciesAllergic Emergencies Disclosures None to report. Funding/Support None to report. Loading ...

OC-002 Team simulation training for medical emergencies in the endoscopy unit

IntroductionMedical simulation is as an attractive way to practice clinical skills to improve confidence, teamwork and outcomes.1 The endoscopy unit is an arena in which a heterogenous group of patients...

Mobile In Situ Obstetric Emergency Simulation and Teamwork Training to Improve Maternal-Fetal Safety in Hospitals

Evidence from other high-risk industries has demonstrated that teamwork skills can be taught and effective teamwork may improve safety. Increasingly, health care providers, hospital administrators, and quality and safety professionals are considering simulation as a strategy to improve quality and patient safety. A mobile obstetric emergency simulation and team training program was created to bring simulation technology and teamwork training used routinely in other high reliability fields directly to health care institutions. A mobile unit constituted a practical approach, given the expense of simulation equipment, the time required for staff to develop educational materials and simulation scenarios, and the need to have a standardized program to promote consistent evaluation across sites. Between 2007 and 2009, in situ simulation of obstetric emergencies and teamwork training was tested with more than 150 health care professionals in labor and delivery units across four rural and two community hospitals in Oregon. HOW DO ORGANIZATIONS DETERMINE WHICH TYPE OF SIMULATION IS BEST FOR THEM? Because simulation technologies are relatively costly to start and maintain, it can be challenging for hospitals and health care professionals to determine which format (send staff to a simulation center, develop in-house simulation program, develop a consortium of hospitals that run a simulation program, or use a mobile simulation program) is best for them. In situ simulation is an effective way to develop new skills, to maintain infrequently used clinical skills even among experienced clinical teams, and to uncover and address latent safety threats in the clinical setting.

Obstetric Emergency Simulation Training: Team Training for Crisis Care Management

Successful management of obstetric emergencies requires the coordinated efforts of a multidisciplinary team of professionals. Simulation training provides an opportunity to learn and master simple as well as complex technical skills needed in emergent situations. “Simulation as a teaching and learning method provides innovative educational experiences to assess and develop clinical competency, promote teamwork, and improve care processes” (Nagle, McHale, & Alexander, 2009, p. 18).

Integrating Team Training Strategies into Obstetrical Emergency Simulation Training

Successful management of obstetrical emergencies such as shoulder dystocia requires the coordinated efforts of a multidisciplinary team of professionals. Simulation education provides an opportunity to learn and master simple as well as complex technical skills needed in emergent situations. Team training has been shown to improve the quality of communication among team members and consequently has an enormous impact on human performance. In the healthcare environment, especially obstetrics where the stakes are high, integrating team training into simulation education can advance efforts to create and sustain a culture of safety. With over 7,100 deliveries annually, our 1,100-bed, two-hospital regional healthcare system embarked on this journey to advance the culture of safety.

Improving shoulder dystocia management among resident and attending physicians using simulations

The objective of the study was to determine whether a simulation-based educational program would improve residents' and attending physicians' performance in a simulated shoulder dystocia. Seventy-one obstetricians participated in an unanticipated simulated shoulder dystocia, an educational debriefing session, and a subsequent shoulder dystocia simulation. Each simulation was scored, based on standardized checklists for 4 technical maneuvers and 6 communication tasks, by 2 physician observers. Paired Student t tests were used for analysis. Forty-three attendings and 28 residents participated. Residents showed significant improvement in mean maneuver (3.3 +/- 0.9 vs 3.9 +/- 0.4, P = .001) and communication (3.5 +/- 1.2 vs 4.9 +/- 1.0, P < .0001) scores after simulation training. Attending physicians' communication (3.6 +/- 1.6 vs 4.9 +/- 1.1, P < .0001) scores were significantly improved after training. Our program improved physician performance in the management of simulated shoulder dystocia deliveries. Obstetric emergency simulation training can improve physicians' communication skills, at all levels of training, and should be incorporated into labor and delivery quality improvement measures.

Development and Use of Mechanical Devices for Simulation of Seizure and Hemorrhage in Obstetrical Team Training

The leading causes of pregnancy-related death are embolism (20%), hemorrhage (17%), and pregnancy-induced hypertension (16%).The Obstetric and Mechanical Engineering Departments at Stanford University worked together to create inexpensive devices that were used in high fidelity simulations to replicate 2 of the leading causes of maternal mortality: hemorrhage and eclampsia (seizure). The mechanisms were designed to behave as similarly as possible to a human patient. The engineering team designed the eclampsia mechanism to jostle the mannequin's head at a frequency and randomness that matched those observed in human generalized seizures. The hemorrhage mechanism was designed to give visual and tactile cues similar to the actual physiology of a pregnant uterus. Both devices were remote controlled. The hemorrhage mechanism was used in a scenario of an amniotic fluid embolism with severe postpartum hemorrhage. The final flow rate was adjustable between 525 and 600 mL/min. The trainees' rapid response and control of the postpartum hemorrhage was deemed to be a vital part of a successful maternal resuscitation. The seizure mechanism was used in a simulation of a pregnant woman in labor with evidence of severe preeclampsia. If the trainees did not recognize the need for treatment of the preeclampsia, the patient simulator had a 45- to 60-second seizure. If corrective actions were not taken, another seizure occurred. The use of remote controlled mechanical devices designed to accurately replicate the visual, auditory, and tactile cues of hemorrhage and eclampsia enhanced high fidelity simulation training in obstetrical emergencies.