1. In-Situ Simulation and ‘Systems Testing’ Dr Pamela Winton Dr David Rowney Royal Hospital for Sick Children Edinburgh

2. Overview of simulation In-situ simulation Our experience A strategy to engage management... ‘Systems Testing’ Group work

3. Clinical Simulation Rapid rise in Clinical Simulation – Technology and Facilities – Litigation and Insurance – Fellowships and Research – Validated for assessment ‘Safer Medical Practice: Machines, Manikins and Polo Mints’ CMO England 2008 ‘A Framework for Technology Enhanced Learning’ DH 2011

4. Evidence MedTeams – Clinical Error reduction from 30% to 4.4% PROMPT – Neonatal hypoxic injuries – 50% reduction – Injuries after shoulder dystocia – 70% reduction – Improvements in performance in Cat 1 sections

5. In-situ Simulation Real time, real areas, real challenges Reveal gaps in the ‘system’ – Equipment, process, training Simulation and Debrief Document information – DATIX, Risk Register, FMEA Analysis, Report Action Re-Test

6. Our experience RHSC Research Facility New Clinical Trial – ‘SNIFFLE Study’ High Risk Anaphylaxis Prospectively test system Re-test In-situ, real time emergency team response

8. Our experience Clinical management Equipment Debrief – Still difficulties accessing area Some issues resolved, some not Solutions? Re-test

9. Activity Work with those around your table and develop a single idea for an in- situ simulation designed to test a workplace system. Your group will be asked to present a summary of your idea, sketched out on flipchart paper, to the room

10. Discuss how you could use simulation for system’s testing in your work place What do you want to test? Why do you want to test this? How would you set it up? What resources will you need? What barriers might you face? What will you do with the findings? When would you ‘re-test’?

11. But we don’t have a fancy manikin! Simulation a technique not a technology... Expertise of facilitator most important element of effective simulation-based education Emergency algorithms, drills

12. In-situ Systems Testing - Novel applications for Simulation Evaluate established work processes and systems Investigate reported errors, faulty systems and patient safety concerns Test new equipment and technologies in real- life setting prior to patient exposure Test, modify, adapt and orient healthcare providers to new processes, services, and facilities before introducing to patients

13. The challenges of in-situ simulation - Real or imagined? Fidelity - highest not always best! Faculty - worth investing in and key to success Time - compromise might need to be met Staff not engaging - high face & content validity means this is the exception rather than the rule Cost - link with patient safety initiatives, engage with management, report findings!

14. Thank you!

15. A framework for the measurement and monitoring of safety Source: Vincent C, Burnett S, Carthey J. The measurement and monitoring of safety. The Health Foundation, 2013. www.health.org.uk/publications/the-measurement-and-monitoring-of-safety