Enhancing systems integration in healthcare using simulation education

Purpose:
The Mortality and the Deteriorating Patient Simulation project (MDPS) created objective, structured, simulation exercises (OSSEs) to improve systems integration for deteriorating patients. This was an enterprise effort with four geographically distinct sites in a wide range of practice settings.

Significance:
In healthcare, systems integration is paramount to prompt care and successful outcomes. In time-dependent situations of critical illness, systems integration is essential to reducing mortality.

Strategy and Implementation:
Each OSSE consisted of partially scripted scenario with a core clinical context relevant to the group participating in the exercise. Imbedded in the clinical context of each OSSE was a component of a challenging development (e.g. clinical deterioration) that necessitated acute systems integration. In addition to this clinical context, some OSSE scripts included components of clinical tension (discord) between providers, typically induced through instructions provided to a single confederate participating in the OSSE. Every OSSE was videotaped to facilitate reflection and to help identify future areas of focus for the respective areas. A structured debriefing to emphasize and teach the cultural and behavioral skills necessary for effective systems integration followed each OSSE.

Evaluation:
Effectiveness of the exercises is being assessed using a combination of clinical metrics and participant questionnaires using a 5 point Likert scale, comparing pre-, post- (early), and 2 month (late) surveys.

Implications for Practice:
Preliminary results indicate important and positive improvements in the knowledge and understanding of cultural and behavioral competency required for safe patient care. Early participant survey responses have indicated approximately 20% improvement in measures of teamwork & systems integration.