Shrestha Roshana, Shrestha Anmol Purna, Shrestha Sanu Krishna, Basnet Samjhana, Pradhan Alok
Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal.
Int J Emerg Med. 2019 Aug 27;12(1):19. doi: 10.1186/s12245-019-0235-x.
Simulation is well established as an effective strategy to train health care professionals in both technical and nontechnical skills and to prevent errors. Despite its known efficacy, adequate implementation is restricted due to the financial burden in resource-limited settings like ours. We therefore pursued to introduce cost-effective in situ simulation (ISS) in the emergency department (ED) to explore its impact on perception and learning experience among multidisciplinary health care professionals and to identify and remediate the latent safety threats (LST).
This is a prospective cross-sectional study with a mixed method research design, which was conducted in the ED of Dhulikhel Hospital-Kathmandu University Hospital. The pretest questionnaire was used to determine baseline knowledge, attitude, and confidence of the staff. The ISS with minimal added cost was conducted involving multidisciplinary healthcare workers. The LSTs were recorded and appropriate remediation was performed. Voluntary post simulation feedback was collected after the sessions.
Overall 56 staff participated in at least one of the 35 simulation sessions, among which 45 (80%) responded to the questionnaires`. Twenty participants (45.5%) were reluctant to use the defibrillator. The self-reported confidence level of using defibrillator was low 29 (64.6%). The knowledge score ranged from 0 to 8 with the median score of 3 and a mean of 3.29 ± 1.8. There was no statistically significant difference in knowledge scores among participants of different occupational backgrounds, previous training, duration of work experience, and previous use of a defibrillator. A total of 366 LSTs {individual (43%), medication (17%), equipment (4%), and system/team (36%)} were identified (10.45 LST per ISS). The overall feedback from the participants was positive. Eighty percent of participants reported increased skills to use a defibrillator, and 82% reported increased confidence for managing such cases. They also agreed upon the need and continuity of such type of simulation in their workplace.
The baseline knowledge score and the confidence level of the staff were low. Self-reported feedback suggested increased confidence level and teamwork skills after ISS. It promoted identification and remediation of latent safety threats. ISS serves as a cost-effective powerful educational model that can be implemented even in settings where finances and space are limited.
模拟已被公认为是一种有效的策略，可用于培训医疗保健专业人员的技术和非技术技能，并预防错误。尽管其效果已得到认可，但在我们这样资源有限的环境中，由于经济负担，其充分实施受到限制。因此，我们致力于在急诊科引入具有成本效益的现场模拟（ISS），以探讨其对多学科医疗保健专业人员认知和学习体验的影响，并识别和纠正潜在的安全威胁（LST）。
这是一项采用混合方法研究设计的前瞻性横断面研究，在加德满都大学杜利凯尔医院急诊科进行。使用预测试问卷来确定工作人员的基线知识、态度和信心。开展了成本增加最少的现场模拟，涉及多学科医护人员。记录潜在安全威胁，并进行适当的纠正。模拟结束后收集自愿的模拟后反馈。
共有56名工作人员参加了35次模拟课程中的至少一次，其中45名（80%）对问卷做出了回应。20名参与者（45.5%）不愿意使用除颤器。自我报告的使用除颤器的信心水平较低，为29名（64.6%）。知识得分范围为0至8分，中位数为3分，平均分为3.29±1.8分。不同职业背景、以前的培训、工作经验时长和以前使用除颤器情况的参与者之间，知识得分没有统计学上的显著差异。共识别出366个潜在安全威胁{个人（43%）、药物（17%）、设备（4%）和系统/团队（36%）}（每次现场模拟10.4个潜在安全威胁）。参与者的总体反馈是积极的。80%的参与者报告使用除颤器的技能有所提高，82%的参与者报告处理此类病例的信心有所增强。他们还认同在工作场所进行此类模拟的必要性和持续性。
工作人员的基线知识得分和信心水平较低。自我报告的反馈表明，现场模拟后信心水平和团队合作技能有所提高。它促进了潜在安全威胁的识别和纠正。现场模拟是一种具有成本效益的强大教育模式，即使在资金和空间有限的环境中也可以实施。
