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Editorial

Five Topics in Health Care Simulation That CouldContribute to Improved Patient Safety

A think tankeconsensus conference was held in Norwayprior to the 2012 Society in Europe for Simulation Applied toMedicine meeting, at the very remote and historical UtsteinAbbey, outside Stavangar, Norway. The first such simulationconsensus conference was held in 2011 in Copenhagen andfocused on educational research topics in health caresimulation. The 2012 meeting addressed five focus areas insimulation that would lead to improved patient safety.Eighteen panel members from a variety of health carepractice disciplines were selected to attend, based on theirinvolvement and merit in simulation in health care andpatient safety and their scientific publications and speakingrecords. Beth Mancini, the president for the Society ofSimulation in Healthcare, and I represented nursing at thisthink tank.

A nominal group technique was used for the conferenceand for decision making. For the first round, we were askedto brainstorm five top topics for patient safety in simula-tion. We sent in these ideas via e-mail several weeks beforethe conference, and our responses were collated. We werethen asked to pick our top 10 topics from the combinedlist of the invited experts. This round forced us to expandour thinking a bit as we were now forced to add anotherfive topics to our lists. The third round of forced choicehad us pick our top five topics from the final list, for discus-sion at the abbey and the consensus conference.

Small groups spent a day and a half in deep thought andreflection to determine the top five topics. I will discussthose final topics from a nursing perspective, in noparticular order. The results were not ranked in any way;no topic was deemed more or less important than anotherfor patient safety.

Technical skills: We know that technical skills are taughtin nursing courses but not necessarily learned or retained.New methodologies and procedures for training are needed,especially for high-risk, low-frequency events. Foley cath-eterization and sterile procedure are two excellent examplesof skills that are not well retained by our students after theubiquitous ‘‘check off.’’ Our biggest challenge is changing

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faculty practice from ‘‘teach one, then done’’ to a more de-liberate practice methodology with repeated opportunitiesfor practice, leading to perfection and retention.

Nontechnical skills: The largest number of votes for anyone topic went to teaching the communication skills re-quired for patient handoffs. The group agreed that thiswas the biggest problem in patient safety that could beaddressed with simulation. The group chose to includecommunication in handoffs in the larger context of non-technical skills, which also included teamwork and inter-professional education. Many participants suggested thatteam training highlights the lack of shared understandingin many patient care situations. The ultimate goal wouldbe to learn and embed shared communication tools andskills such as situation, background, assessment, and rec-ommendation (the SBAR system) into routine education.In addition, patients should ultimately also be included inthis training. Actual critical incidents from practice couldbe used to highlight the issues and communication skillsneeded to navigate today’s health care system.

Using simulation for systems probing was chosen as itprovides a safe and cost-effective way to provide informa-tion about existing but unidentified patient safety problemswithin a unit or care system. Systems probes of processessuch as transferring a patient to surgery or postoperativecare, testing the impact of a change prior to actual imple-mentation, and using more quality improvement methodol-ogy were all included in this idea.

Effectiveness of simulation in actual patient outcomeswas also a major topic. Demonstrating the effectivenessand cost efficiency of simulation is difficult to do and iscostly. Studies demonstrating the effectiveness of simula-tion education are equivocal at this time, across disciplines.Whole systems need to be trained or retrained to effect no-table differences in patient outcomes.

Using simulation for assessment, credentialing, pro-fessional certification, and effectiveness outcomes wasdiscussed as a key topic in patient safety. Improved as-sessment of both medical and nursing education and

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Editorial e322

initial credentialing was discussed at length. Improvedassessment of educational in schools prior to licensureor in conjunction with licensure would improve our ac-countability to the public and to our profession at large.Nursing is taking a leading role in this effort, with boththe National Council of State Boards of Nursing studyand the National League for Nursing high-stakes evalua-tion study.

To summarize, the ultimate goal of simulation is better-educated providers and improved patient care outcomes.

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Without these two outcomes, simulation may be justanother very expensive fad.

Suzie Kardong-Edgren, PhD, RN, ANEFResearch Associate Professor

Jody DeMeyer Endowed Chair in NursingBoise State UniversityBoise, ID 83725, USA

E-mail address: sedgren@boisestate.eduEditor-in Chief, Clinical Simulation in Nursing

e322 � Clinical Simulation in Nursing � Volume 8 � Issue 8