Research Activities, November-December 2013
Simulation exercises can improve patient safety
Patient Safety and Quality
The old adage "practice makes perfect" applies to medicine just as it does to other fields. With today's technically advanced patient simulators, clinicians can practice procedures before performing them on a patient.
A recent literature review found that various simulation interventions do improve the technical performance of clinicians and health care teams during critical events and can be viewed as an effective patient safety strategy. A total of 38 studies were included in the study, with 22 of them being randomized clinical trials. Another 11 were prospective observational studies. The remaining 5 consisted of a retrospective analysis of a previous simulation.
Six studies showed that physicians performed colonoscopy and upper gastrointestinal endoscopy better on real patients after receiving training with a simulator. In the case of laparoscopic surgery, procedure times were no faster after training with virtual reality simulators versus the traditional video approach. However, simulation training for gall bladder removal resulted in threefold fewer errors and an eightfold decreased variation in errors.
There was also improved performance and a greater respect for tissue during surgery. One particular study described 11 dimensions that need to be considered when designing and setting up simulation exercises. The objectives of implementation must be aligned with learners' needs as well as the trainers' goals for a particular procedure. There must also be adequate time set aside for debriefing. Costs vary dramatically depending on the type of exercise, equipment, and personnel. Overall, simulation-based exercises increase technical and procedural performance at the physician and team level across multiple medical specialties and procedures.
While simulation can improve patient safety, more research is needed to determine how simulation actually contributes to differences in patient safety outcomes at the health system level. The study was supported by AHRQ (Contract No. 290-07-10062).
See "Simulation exercises as a patient safety strategy," by Eric Schmidt, B.A., Sara N. Goldhaber-Fiebert, M.D., Lawrence A. Ho, M.D., and Kathryn M. McDonald, M.M., in the March 5, 2013, Annals of Internal Medicine 158(5) (part 2), pp. 426-432.