Rusiecki Daniel, Walker Melanie, Douglas Stuart L, Hoffe Sharleen, Chaplin Timothy
School of Medicine, Queen's University, Kingston, Canada.
School of Medicine, Emergency Medicine, Public Health Sciences, Queen's University, Kingston, Canada.
BMJ Simul Technol Enhanc Learn. 2020 Sep 23;7(2):102-107. doi: 10.1136/bmjstel-2020-000621. eCollection 2021.
To describe the association between participant profession and the number and type of latent safety threats (LSTs) identified during in situ simulation (ISS). Secondary objectives were to describe the association between both (a) participants' years of experience and LST identification and (b) type of scenario and number of identified LSTs.
Emergency staff physicians (MDs), registered nurses (RNs) and respiratory therapists (RTs) participated in ISS sessions in the emergency department (ED) of a tertiary care teaching hospital. Adult and paediatric scenarios were designed to be high-acuity, low-occurrence resuscitation cases. Simulations were 10 min in duration. A written survey was administered to participants immediately postsimulation, collecting demographic data and perceived LSTs. Survey data was collated and LSTs were grouped using a previously described framework.
Thirteen simulation sessions were completed from July to November 2018, with 59 participants (12 MDs, 41 RNs, 6 RTs). Twenty-four unique LSTs were identified from survey data. RNs identified a median of 2 (IQR 1, 2.5) LSTs, significantly more than RTs (0.5 (IQR 0, 1.25), p=0.04). Within respective professions, MDs and RTs most commonly identified equipment issues, and RNs most commonly identified medication issues. Participants with ≤10 years of experience identified a median of 2 (IQR 1, 3) LSTs versus 1 (IQR 1, 2) LST in those with >10 years of experience (p=0.06). Adult and paediatric patient scenarios were associated with the identification of a median of 4 (IQR 3.0, 4.0) and 5 LSTs (IQR 3.5, 6.5), respectively (p=0.15).
Inclusion of a multidisciplinary team is important during ISS in order to gain a breadth of perspectives for the identification of LSTs. In our study, participants with ≤10 years of experience and simulations with paediatric scenarios were associated with a higher number of identified LSTs; however, the difference was not statistically significant.
描述参与者职业与现场模拟（ISS）期间识别出的潜在安全威胁（LST）的数量和类型之间的关联。次要目的是描述（a）参与者的工作年限与LST识别之间以及（b）场景类型与识别出的LST数量之间的关联。
急诊专科教学医院急诊科的急诊内科医生（MD）、注册护士（RN）和呼吸治疗师（RT）参与了ISS环节。成人和儿科场景设计为高急症、低发生率的复苏病例。模拟时长为10分钟。模拟结束后立即对参与者进行书面调查，收集人口统计学数据和感知到的LST。整理调查数据，并使用先前描述的框架对LST进行分组。
2018年7月至11月完成了13次模拟环节，共有59名参与者（12名MD、41名RN、6名RT）。从调查数据中识别出24种不同的LST。RN识别出的LST中位数为2（四分位间距1，2.5），显著多于RT（0.5（四分位间距0，1.25），p = 0.04）。在各自职业中，MD和RT最常识别出设备问题，而RN最常识别出用药问题。工作年限≤10年的参与者识别出的LST中位数为2（四分位间距1，3），而工作年限>10年的参与者为1（四分位间距1，2）（p = 0.06）。成人和儿科患者场景分别与识别出的LST中位数4（四分位间距3.0，4.0）和5（四分位间距3.5，6.5）相关（p = 0.15）。
在ISS期间纳入多学科团队对于获得识别LST的广泛视角很重要。在我们的研究中，工作年限≤10年的参与者以及儿科场景模拟与识别出的LST数量较多相关；然而，差异无统计学意义。
