Shapiro Fred E, Pawlowski John B, Rosenberg Noah M, Liu Xiaoxia, Feinstein David M, Urman Richard D
Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Mass.
University of Massachusetts Memorial Medical Center, Worcester.
Eplasty. 2014 Jan 9;14:e2. eCollection 2014.
Simulation-based interventions and education can potentially contribute to safer and more effective systems of care. We utilized in-situ simulation to highlight safety issues, regulatory requirements, and assess perceptions of safety processes by the plastic surgery office staff.
A high-fidelity human patient simulator was brought to an office-based plastic surgery setting to enact a half-day full-scale, multidisciplinary medical emergency. Facilitated group debriefings were conducted after each scenario with special consideration of the principles of team training, communication, crisis management, and adherence to evidence-based protocols and regulatory standards. Abbreviated AHRQ Medical Office Safety Culture Survey was completed by the participants before and after the session.
The in-situ simulations had a high degree of acceptance and face validity according to the participants. Areas highlighted by the simulation sessions included rapid communication, delegation of tasks, location of emergency materials, scope of practice, and logistics of transport. The participant survey indicated greater awareness of patient safety issues following participation in simulation and debriefing exercises in 3 areas (P < 0.05): the need to change processes if there is a recognized patient safety issue (100% vs 75%), openness to ideas about improving office processes (100% vs 88%), and the need to discuss ways to prevent errors from recurring (88% vs 62%).
Issues of safety and regulatory compliance can be assessed in an office-based setting through the short-term (half-day) use of in-situ simulation with facilitated debriefing and the review of audiovisual recordings by trained facilities inspectors.
基于模拟的干预措施和教育可能有助于建立更安全、更有效的护理系统。我们采用现场模拟来突出安全问题、监管要求，并评估整形外科办公室工作人员对安全流程的看法。
将高保真人体患者模拟器带到整形外科办公室环境中，模拟一场为期半天的全面多学科医疗紧急情况。在每个场景结束后进行小组引导式汇报，特别考虑团队培训、沟通、危机管理以及遵循循证方案和监管标准等原则。参与者在课程前后完成简化版的AHRQ医疗办公室安全文化调查。
参与者认为现场模拟具有高度的可接受性和表面效度。模拟环节突出的领域包括快速沟通、任务分配、应急物资存放位置、执业范围和运输后勤。参与者调查显示，在参与模拟和汇报练习后，在三个方面对患者安全问题的认识有所提高（P < 0.05）：如果识别出患者安全问题就需要改变流程（100%对75%）、对改进办公室流程的想法持开放态度（100%对88%）以及需要讨论防止错误再次发生的方法（88%对62%）。
通过短期（半天）使用现场模拟并进行引导式汇报，以及由受过培训的设施检查员审查视听记录，可以在办公室环境中评估安全和监管合规问题。
