Nottingham University Hospitals Trust, Institute of Care Excellence, Nottingham, UK.
Birmingham Children's Hospital, Birmingham, UK.
BMC Med Educ. 2022 Jul 11;22(1):537. doi: 10.1186/s12909-022-03401-y.
In-situ simulation is increasingly employed in healthcare settings to support learning and improve patient, staff and organisational outcomes. It can help participants to problem solve within real, dynamic and familiar clinical settings, develop effective multidisciplinary team working and facilitates learning into practice. There is nevertheless a reported lack of a standardised and cohesive approach across healthcare organisations. The aim of this systematic mapping review was to explore and map the current evidence base for in-situ interventions, identify gaps in the literature and inform future research and evaluation questions.
A systematic mapping review of published in-situ simulation literature was conducted. Searches were conducted on MEDLINE, EMBASE, AMED, PsycINFO, CINAHL, MIDIRS and ProQuest databases to identify all relevant literature from inception to October 2020. Relevant papers were retrieved, reviewed and extracted data were organised into broad themes.
Sixty-nine papers were included in the mapping review. In-situ simulation is used 1) as an assessment tool; 2) to assess and promote system readiness and safety cultures; 3) to improve clinical skills and patient outcomes; 4) to improve non-technical skills (NTS), knowledge and confidence. Most studies included were observational and assessed individual, team or departmental performance against clinical standards. There was considerable variation in assessment methods, length of study and the frequency of interventions.
This mapping highlights various in-situ simulation approaches designed to address a range of objectives in healthcare settings; most studies report in-situ simulation to be feasible and beneficial in addressing various learning and improvement objectives. There is a lack of consensus for implementing and evaluating in-situ simulation and further studies are required to identify potential benefits and impacts on patient outcomes. In-situ simulation studies need to include detailed demographic and contextual data to consider transferability across care settings and teams and to assess possible confounding factors. Valid and reliable data collection tools should be developed to capture the complexity of team and individual performance in real settings. Research should focus on identifying the optimal frequency and length of in-situ simulations to improve outcomes and maximize participant experience.
原位模拟越来越多地应用于医疗保健环境中，以支持学习并改善患者、员工和组织的结果。它可以帮助参与者在真实、动态和熟悉的临床环境中解决问题，发展有效的多学科团队合作，并促进学习转化为实践。然而，据报道，医疗保健组织之间缺乏标准化和协调一致的方法。本系统映射综述的目的是探索和绘制原位干预措施的现有证据基础，确定文献中的空白，并为未来的研究和评估问题提供信息。
对已发表的原位模拟文献进行系统映射综述。在 MEDLINE、EMBASE、AMED、PsycINFO、CINAHL、MIDIRS 和 ProQuest 数据库中进行了搜索，以确定从开始到 2020 年 10 月的所有相关文献。检索相关论文，进行审查，并将提取的数据组织成广泛的主题。
共纳入 69 篇映射综述论文。原位模拟 1) 用作评估工具；2) 评估和促进系统准备和安全文化；3) 提高临床技能和患者结果；4) 提高非技术技能 (NTS)、知识和信心。大多数纳入的研究是观察性的，根据临床标准评估个人、团队或部门的绩效。评估方法、研究长度和干预频率差异很大。
本映射突出了各种原位模拟方法，旨在解决医疗保健环境中的一系列目标；大多数研究报告原位模拟在解决各种学习和改进目标方面是可行且有益的。在实施和评估原位模拟方面缺乏共识，需要进一步研究以确定对患者结果的潜在益处和影响。原位模拟研究需要包括详细的人口统计学和背景数据，以考虑在护理环境和团队之间的可转移性，并评估可能的混杂因素。应开发有效和可靠的数据收集工具，以捕捉真实环境中团队和个人绩效的复杂性。研究应侧重于确定改善结果和最大限度地提高参与者体验的原位模拟的最佳频率和长度。
