Raemer Daniel B
From the Center for Medical Simulation and Harvard Medical School, Boston, MA.
Simul Healthc. 2014 Jun;9(3):153-5. doi: 10.1097/SIH.0000000000000016.
The story of Ignaz Semmelweis suggests a lesson to beware of unintended consequences, especially with in situ simulation. In situ simulation offers many important advantages over center-based simulation such as learning about the real setting, putting participants at ease, saving travel time, minimizing space requirements, involving patients and families. Some substantial disadvantages include frequent distractions, lack of privacy, logistics of setup, availability of technology, and supply costs. Importantly, in situ simulation amplifies some of the safety hazards of simulation itself including maintaining control of simulated medications and equipment, limiting the use of valuable hospital resources, preventing incorrect learning from simulation shortcuts, and profoundly upsetting patients and their families. Mitigating these hazards by labeling effectively, publishing policies and procedures, securing simulation supplies and equipment, educating simulation staff, and informing participants of the risks are all methods that may lessen the potential for an accident. Each requires a serious effort of analysis, design, and implementation.
伊格纳兹·塞麦尔维斯的故事给我们上了一课，要警惕意外后果，尤其是在现场模拟方面。与基于中心的模拟相比，现场模拟有许多重要优势，比如了解真实环境、让参与者放松、节省出行时间、减少空间需求、让患者和家属参与其中。一些明显的劣势包括频繁的干扰、缺乏隐私、设置的后勤工作、技术可用性以及供应成本。重要的是，现场模拟放大了模拟本身的一些安全隐患，包括对模拟药物和设备的管控、限制宝贵医院资源的使用、防止因模拟捷径导致错误学习，以及极大地扰乱患者及其家属。通过有效贴标签、发布政策和程序、确保模拟用品和设备安全、培训模拟工作人员以及告知参与者风险等方式来减轻这些隐患，都是可以降低事故可能性的方法。每一种都需要认真进行分析、设计和实施。
