By: Victoria Brazil (@SocraticEM)
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“Hey can we do some sims to test our new airway checklist?”, asked the emergency physician.
“Sure”. The simulation program lead was excited to get the request. “Where are you up to in the design phase? Are you still working on the optimal process, or are you testing a cognitive aid?”
The response from the emergency physician was a blank look.
“Umm no. we already have the checklist. I thought we could use the simulations to train the residents and nurses how to use it?
This fictional exchange draws attention to an important issue in healthcare simulation – clarity of objectives. It also illuminates a shift in focus for some healthcare simulation practice, toward more directly targeting quality improvement and healthcare systems. But how can these new objectives be achieved? How should we think about this emerging purpose for healthcare simulation? Do we need to adjust our simulation processes (design, delivery, debriefing) to achieve those aims? These questions are explored in my recent publication, with co-author Gabriel Reedy: “Translational simulation revisited: an evolving conceptual model for the contribution of simulation to healthcare quality and safety.”(1)
In the article, we describe the critical (and effective) role of simulation in the education and training of healthcare professionals and teams. Using the example above, the ED airway teams do need to learn about and practice using the checklist. However, the article also offers a provocation for the simulation community – that reliance on educational paradigms may fail to realise the full potential of simulation to contribute to quality and safety in healthcare. Maybe that airway checklist could have been better designed to accommodate human factors and other design principles? Maybe our airway equipment cart could be better set up? Maybe our systems for notifying relevant staff that an airway emergency is occurring could be more effective? Simulation may be able to help with each of these.
The article covers evolving practice in translational simulation over the last 6 years: preparing health services for the COVID-19 pandemic, supporting hospital relocation or physical space testing, testing clinical pathways and processes, and shaping culture and teamwork in healthcare settings. We then offer a graphical representation of an evolving conceptual framing for translational simulation with three core elements: purpose, process, and conceptual foundations. (Figure 1.) The aim is to provide a conceptual model applicable to a wide range of simulation applications, providing clarity for simulation practitioners, researchers and health service leaders.
Our airway checklist example highlights one underutilized ‘purpose’ for simulation: developing and testing clinical pathways. There is some excellent work in this area. Marshal et. al. used simulated anaesthesia crises to show that cognitive aids for intra-operative anaphylaxis improves team co-ordination, communication, and overall performance. Further, the testing revealed that some cognitive aids were better than others; ‘linear’ designs (i.e. simple sequence of actions) may be more effective than complex branched aids (i.e. ‘if/ then’ decision points). The finding is important, but the process of testing is an exemplar for translational simulation. Aiming for a similar purpose, Woodward et. al. describe a method for utilizing simulation in the design of a clinical practice tool: a prototype track-and-trigger chart for detecting and responding to possible fetal deterioration during labour. This author team then describe a framework that I think would be useful for any clinician or quality improvement specialist charged with developing clinical pathways. And this simulation doesn’t need to be technically complex. Ben Symon and team describe using a simple set up of 2 dialysis bags to test their massive haemorrhage protocol. This is exciting and important work connecting simulation with quality improvement in healthcare. For more on this, the first 2 articles are reviewed here on Simulcast.
This theory work is all very well, but what does this mean for the simulation practitioner based in a health service?
- Keep doing your excellent simulation-based education and training. This has a valuable role in supporting healthcare performance.
- Look for ways to connect training to systems issues. Ask your simulation participants if the systems and processes in their department are working for them, and prompt reflection on whether they can be optimized. Seek to uncover ‘tacit’ expertise among experienced providers about how they navigate those systems.
- Knock on the door of your health service quality and safety team. Maybe we can work together on a project where simulation can be a helpful ‘test bed’ for planned changes.
- Consider a short course or further study in human factors, quality improvement practice, or safety science. Exploring these parallel practice fields might provide new perspectives on how simulation could be used for local challenges.
- Dive into the list of references in the paper. There are dozens of examples of translational simulation work that may be relevant to your practice.
Happy simulating!
Vb
Photo from Istock
References
- Brazil, V., Reedy, G. Translational simulation revisited: an evolving conceptual model for the contribution of simulation to healthcare quality and safety. Adv Simul 9, 16 (2024).
- Marshall, S.D., Sanderson, P., McIntosh, C.A. and Kolawole, H. (2016), The effect of two cognitive aid designs on team functioning during intra-operative anaphylaxis emergencies: a multi-centre simulation study. Anaesthesia, 71: 389-404.
- Woodward M, Dixon-Woods M, Randall W, et a. How to co-design a prototype of a clinical practice tool: a framework with practical guidance and a case study. BMJ Quality & Safety (2024) 33:258-270.
- Symon, B., Gourlay, K., Bauer, L., Hufton, D. (2023). A simple massive haemorrhage protocol simulation using two dialysis bags. International Journal of Healthcare Simulation.
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