Houze-Cerfon Charles-Henri, Vaissié Christine, Gout Laurent, Bastiani Bruno, Charpentier Sandrine, Lauque Dominique
Emergency Department, Toulouse University Hospital, Toulouse, France.
Institut Toulousain de Simulation en Santé, Toulouse, France.
JMIR Serious Games. 2019 Aug 8;7(3):e13993. doi: 10.2196/13993.
Despite a wide range of literature on emergency department (ED) overcrowding, scientific knowledge on emergency physicians' cognitive processes coping with overcrowding is limited.
This study aimed to develop and evaluate a virtual research environment that will allow us to study the effect of physicians' strategies and behaviors on quality of care in the context of ED overcrowding.
A simulation-based observational study was conducted over two stages: the development of a simulation model and its evaluation. A research environment in emergency medicine combining virtual reality and simulated patients was designed and developed. Afterwards, 12 emergency physicians took part in simulation scenarios and had to manage 13 patients during a 2-hour period. The study outcome was the authenticity of the environment through realism, consistency, and mastering. The realism was the resemblance perceived by the participants between virtual and real ED. The consistency of the scenario and the participants' mastering of the environment was expected for 90% (12/13) of the participants.
The virtual ED was considered realistic with no significant difference from the real world with respect to facilities and resources, except for the length of time of procedures that was perceived to be shorter. A total of 100% (13/13) of participants deemed that patient information, decision making, and managing patient flow were similar to real clinical practice. The virtual environment was well-mastered by all participants over the course of the scenarios.
The new simulation tool, Virtual Research Environment in Emergency Medicine, has been successfully designed and developed. It has been assessed as perfectly authentic by emergency physicians compared with real EDs and thus offers another way to study human factors, quality of care, and patient safety in the context of ED overcrowding.
尽管有大量关于急诊科过度拥挤的文献，但关于急诊医生应对过度拥挤的认知过程的科学知识有限。
本研究旨在开发和评估一种虚拟研究环境，使我们能够在急诊科过度拥挤的背景下研究医生的策略和行为对医疗质量的影响。
进行了一项基于模拟的观察性研究，分为两个阶段：模拟模型的开发及其评估。设计并开发了一个结合虚拟现实和模拟患者的急诊医学研究环境。之后，12名急诊医生参与模拟场景，在2小时内必须处理13名患者。研究结果是通过逼真度、一致性和掌控度来衡量环境的真实性。逼真度是参与者所感知到的虚拟急诊科与真实急诊科之间的相似程度。预计90%（12/13）的参与者能实现场景的一致性以及对环境的掌控。
虚拟急诊科被认为是逼真的，在设施和资源方面与现实世界没有显著差异，只是手术时间被认为较短。共有100%（13/13）的参与者认为患者信息、决策制定和患者流程管理与实际临床实践相似。在整个场景过程中，所有参与者都很好地掌控了虚拟环境。
新的模拟工具“急诊医学虚拟研究环境”已成功设计和开发。与真实急诊科相比，急诊医生认为它具有完美的真实性，因此为在急诊科过度拥挤的背景下研究人为因素、医疗质量和患者安全提供了另一种途径。
