Sarwani Nada, Sulaiman Saad, O'Keeffe Dara
Anaesthesia, Salmaniya Medical Complex - Government Hospitals, Manama, BHR.
Internal Medicine, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, GBR.
Cureus. 2025 Jul 7;17(7):e87430. doi: 10.7759/cureus.87430. eCollection 2025 Jul.
A high-risk acute care area, such as the operating room (OR), requires seamless teamwork for the provision of safe care due to its fast-paced nature. Any breakdown in teamwork in this high-stakes setting could lead to adverse patient outcomes. Simulation-based team training strategies adopted from the principles of Crew Resource Management (CRM) from the aviation industry are a prominent modality used to train multispecialty teams in the OR. While sufficient evidence in the literature highlights the positive behavioral attitudes and improved non-technical skills of the OR teams, this review aims to examine and assess the impact of interprofessional point-of-care simulation training in the OR on patient safety and clinical outcomes. A scoping review methodology was employed for comprehensive and iterative evidence research across five electronic databases. Methodological rigor was assessed using the Quality Assessment Tool for Studies with Diverse Designs, followed by thematic analysis of the extracted data and systematic mapping of the literature. A total of 110 papers were screened, with 35 full-text articles assessed for eligibility. Twelve studies were included in the review with the identification of three recurring themes highlighting the impact of in situ simulation training in the OR on healthcare teams, clinical outcomes, and patient safety: 1) impact on team behavior, attitude, and non-technical skills; 2) identification of latent safety threats; and 3) clinical outcomes, morbidity, and mortality. Simulation training in in situ settings offers multidisciplinary OR teams an opportunity to practice high-risk procedures in a controlled environment. It allows teams to overcome organizational barriers through the development of human factors and non-technical skills among healthcare professionals and identify latent safety threats to proactively address potential causes of error and harm, reflecting a constructive impact on patient safety. However, more research is warranted to demonstrate the direct influence of in situ simulation-based OR team training on clinical outcomes through standardized assessment tools, prompting initiatives aimed at improvement, and advocating for the incorporation of in situ simulation as a valuable component in the quality improvement cycle within the healthcare sector.
高风险急性护理区域，如手术室（OR），由于其节奏快的特点，需要无缝协作以提供安全护理。在这种高风险环境中，团队协作的任何失误都可能导致不良的患者结局。从航空业的机组资源管理（CRM）原则采用的基于模拟的团队培训策略是用于培训手术室多专业团队的一种突出方式。虽然文献中有足够的证据突出了手术室团队积极的行为态度和提高的非技术技能，但本综述旨在检查和评估手术室跨专业床边模拟培训对患者安全和临床结局的影响。采用范围综述方法对五个电子数据库进行全面且反复的证据研究。使用针对不同设计研究质量评估工具评估方法的严谨性，随后对提取的数据进行主题分析并对文献进行系统映射。共筛选了110篇论文，评估了35篇全文文章的 eligibility。本综述纳入了12项研究，识别出三个反复出现的主题，突出了手术室现场模拟培训对医疗团队、临床结局和患者安全的影响：1）对团队行为、态度和非技术技能的影响；2）识别潜在安全威胁；3）临床结局、发病率和死亡率。现场环境中的模拟培训为多学科手术室团队提供了在受控环境中练习高风险程序的机会。它使团队能够通过培养医疗专业人员的人为因素和非技术技能来克服组织障碍，并识别潜在安全威胁以主动解决潜在的错误和伤害原因，这对患者安全产生了建设性影响。然而，需要更多研究通过标准化评估工具来证明基于现场模拟的手术室团队培训对临床结局的直接影响，推动旨在改进的举措，并倡导将现场模拟纳入医疗保健部门质量改进周期中的重要组成部分。
