Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, USA.
Department of Emergency Medicine, White Plains Hospital, White Plains, New York, USA.
Otolaryngol Head Neck Surg. 2020 Aug;163(2):250-258. doi: 10.1177/0194599820923659. Epub 2020 May 26.
Our objectives were (1) to use in situ simulation to assess the clinical environment and identify latent safety threats (LSTs) related to the management of pediatric tracheostomy patients and (2) to analyze the effects of systems interventions and team factors on LSTs and simulation performance.
A multicenter, prospective study to assess LSTs related to pediatric tracheostomy care management was conducted in emergency departments (EDs) and intensive care units (ICUs). LSTs were identified through equipment checklists and in situ simulations via structured debriefs and blinded ratings of team performance. The research team and unit champions developed action plans with interventions to address each LST. Reassessment by equipment checklists and in situ simulations was repeated after 6 to 9 months.
Forty-one LSTs were identified over 21 simulations, 24 in the preintervention group and 17 in the postintervention group. These included LSTs in access to equipment (ie, availability of suction catheters, lack of awareness of the location of tracheostomy tubes) and clinical knowledge gaps. Mean equipment checklist scores improved from 76% to 87%. Twenty-one unique teams (65 participants) participated in the simulations. The average simulation score was 6.19 out of 16 points.
In situ simulation is feasible and effective as an assessment tool to identify latent safety threats and thus measure the system-level performance of a clinical care environment.
In situ simulation can be used to identify and reassess latent safety threats related to pediatric tracheostomy management and thereby support quality improvement and educational initiatives.
我们的目的是（1）使用现场模拟评估临床环境并确定与小儿气管切开患者管理相关的潜在安全威胁（LSTs），以及（2）分析系统干预措施和团队因素对 LSTs 和模拟表现的影响。
一项多中心、前瞻性研究在急诊科（ED）和重症监护病房（ICU）中评估与小儿气管切开护理管理相关的 LSTs。通过设备检查表和现场模拟，通过结构化的汇报和对团队表现的盲评，确定 LSTs。研究团队和单位负责人制定了行动计划，其中包括针对每个 LST 的干预措施。在 6 至 9 个月后，通过设备检查表和现场模拟进行重新评估。
在 21 次模拟中发现了 41 个 LSTs，其中 24 个在干预前组，17 个在干预后组。这些 LSTs 包括设备获取方面的问题（即，吸引导管的可用性，对气管切开管位置的认识不足）和临床知识差距。平均设备检查表得分从 76%提高到 87%。21 个独特的团队（65 名参与者）参与了模拟。模拟平均得分为 16 分中的 6.19 分。
现场模拟作为一种评估工具，可用于识别潜在安全威胁，从而衡量临床护理环境的系统性能，具有可行性和有效性。
现场模拟可用于识别和重新评估与小儿气管切开管理相关的潜在安全威胁，从而支持质量改进和教育计划。
