Imitating Incidents: How Simulation Can Improve Safety Investigation and Learning From Adverse Events

Simulation in Healthcare : Journal of the Society for Simulation in Healthcare
Carl Macrae

Abstract

One of the most fundamental principles of patient safety is to investigate and learn from the past in order to improve the future. However, healthcare organizations can find it challenging to develop the robust organizational processes and work practices that are needed to rigorously investigate and learn from safety incidents. Key challenges include difficulties developing specialist knowledge and expertise, understanding complex incidents, coordinating collaborative action, and positively changing practice. These are the types of challenges that simulation is commonly used to address. As such, this article proposes that there are considerable opportunities to integrate simulation more deeply and systematically into routine efforts to investigate and learn from safety incidents. This article explores how this might be performed by defining five key areas where simulation could be productively integrated throughout the investigation and learning process, drawing on examples of current practice and analogous applications in healthcare and other industries.

References

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Jan 10, 2014·Simulation in Healthcare : Journal of the Society for Simulation in Healthcare·Kathleen M VentreGwyn Barley
Nov 2, 2014·Journal of the Royal Society of Medicine·Carl Macrae, Charles Vincent
Sep 9, 2015·BMJ Quality & Safety·Carl Macrae
Dec 10, 2015·Simulation in Healthcare : Journal of the Society for Simulation in Healthcare·Michael A RosenSallie J Weaver
Apr 5, 2016·Simulation in Healthcare : Journal of the Society for Simulation in Healthcare·Paul E PhrampusSusan Martin
Oct 21, 2016·Anesthesia and Analgesia·Naola AustinSteven Lipman

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Citations

Oct 2, 2019·Pediatric Quality & Safety·Nora ColmanKiran B Hebbar
Jun 27, 2020·Academic Medicine : Journal of the Association of American Medical Colleges·Emily HillmanBetty Drees
Jan 16, 2021·Pediatric Annals·Anja ZannTensing Maa
Aug 17, 2020·Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN·UNKNOWN Association of Women’s Health, Obstetric and Neonatal Nurses
Apr 28, 2020·Emergency Medicine Clinics of North America·Barbara M WalshStephanie Stapleton
Aug 17, 2020·Nursing for Women's Health·UNKNOWN Association of Women’s Health, Obstetric and Neonatal Nurses
Aug 3, 2019·Chest·Nitin SeamLillian Emlet
Jul 18, 2020·Simulation in Healthcare : Journal of the Society for Simulation in Healthcare·Jeffrey B Cooper

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