Using Simulation to Improve Safety in Patient Care: Did I Do That?
Preventable medical errors are listed as the third leading cause of death in the United States, claiming anywhere between 250,000 and 400,000 lives annually. As a result, health care providers must address crucial components of patient safety. Following the lead of the aviation industry, simulation in health care has evolved to focus attention on the importance of interprofessional communication, critical thinking, psychomotor skills, clinical judgement and decision making as a means of furthering patient safety and reducing catastrophic medical errors. Simulation has demonstrated its efficacy as a tool in promoting safety patient care through practiced human interaction, cooperation, and interprofessional collaboration.
The primary focal points of simulation are the enhancement of patient safety and the reduction of health care error. Such objectives are attained as participants practice simulated patient scenarios in a safe environment wherein, they make mistakes as part of the learning process. In doing so, participants become aware of their own practices, reflecting on measures to improve. Each member of the simulation team brings unique experience and background to the learning process. Through implementation of Kolb’s experiential learning model in simulation, health care providers progress through the phases of concrete experience (the actual simulation scenario in which each participant performs at his/her best level), reflective observation (application of critical thinking to the behaviors that occurred during the simulation scenario), abstract conceptualization (participants consider the relevance of the experience and stimulate new ideas and practices), and active experimentation (participants test newly learned practices in additional simulation scenarios). Each phase aids in the promotion of interprofessional communication, development of critical thinking and clinical judgement, refinement of psychomotor skills, ultimately improving the efficacy of practice.
As skills are practiced and refined, simulation participants go through the process of implementing new practices, receiving further feedback throughout. The cycle may be repeated as many times as necessary to further learning. Participants are encouraged throughout the simulation learning process to examine their own beliefs and experiences and develop an awareness of their environment and resources. Using simulation as an essential training tool ultimately enhances mutual respect throughout the health care team, improves patient outcomes, and creates a culture of safety that should be the hallmark of optimal patient care.
That brings us to ‘what did I do and did I do that?’ This phrase or similar phrases may be heard in the practice arena. All too often it is written about in journals and on occasionally with unfortunate regret we must read in local, national and international news of a lost patient due to the error of a comrade. It is then we hear ourselves asking the perennial questions: “What happened?” “Why?” “What got missed?” “How could it have been prevented?” Often, we conclude the dismal truth that the tragedy or lost could have been prevented. Something must be done; something has to be done. One tragedy is too much. One lost is too much.
It is with this consciousness that we think of how to reach our practitioners at a level where we teach in a practice setting; a setting free of criticism and bursting with content that explains, tracks behaviors, illuminates actions, reveals systemic mix-ups and messes that belie the real intent of our practice. This setting affords and encourages a space for truth about error both near misses and errors committed. The system for reporting these errors must be transparent and free of fear of reprisal. It is here where we start to recognize the need for change; the change has to be implemented in practice everywhere. We must be open about errors, near misses and outright mistakes in our practice. The mode of practice should start with truth and concern for a transparent reporting system without fear of retaliation once the error/mistake is conceded.
Then, an approach to restructuring systems that cause practitioners to fail or systems that do not support a practitioner to successful provide care for those whose welfare in them is entrusted. Simulation has been recognized as a key piece of the restructuring which allows practitioners to practice many skills in a safe lab setting. Practicing and then rinse and repeat practice of procedures and practice activity enables a care provider/practitioner to become more adept with treatment provisions. When practitioners and care providers hone skills and become master practitioners, they are more confident and more skilled; this is the net result, the upshot, of simulation. This is why we simulate. The goal is to prevent error, to avoid near misses and ultimately the goal is no loss of life. When we say, “Did I do that?” that is saving a life.
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