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  • Publication # 14-RA004

Simulation training in the hospital unit improves the quality of emergency response teams

Emergency Care

High-reliability emergency response teams respond to patients who are early identified as developing impending cardiorespiratory failure inside the hospital (a code blue). These teams are used in pediatric hospitals, such as Cincinnati Children's Hospital Medical Center (CCHMC). Their teams have been associated with significantly decreased emergency codes outside critical care areas and a reduction in hospital mortality. Training such teams takes work. Recently, CCHMC described their use of in situ simulation training to improve the delivery of quality care. 

The researchers found that by performing these simulations in the clinical unit, knowledge gaps and latent safety threats were identified. In addition, teamwork was reinforced among the members. Simulations were unannounced and performed twice per month in units on a rotating basis and schedule. The hospital conducted 64 in situ simulations on all shifts and units during a 21-month period. Actual resuscitation equipment carts were used—the same ones counted on during true code situations. Each simulation was 10 minutes in length followed by a 10-minute debriefing. 

A total of 134 latent safety threats (threats to patient safety that can happen at any time and are earlier unrecognized by staff) and knowledge gaps were identified from the simulations. Such threats are considered accidents waiting to happen. This amounted to 2.1 latent safety threats per each simulation. For example, 3 resuscitation equipment carts were located in non-clinical areas and not readily available. They are now stocked with portable suction and oxygen cylinders. Laryngeal mask airways have also been added to all carts. 

In another simulation, a nurse incorrectly diluted amiodarone, a drug used to treat heart rhythm problems. This resulted in different package labeling, adding a backup clinical pharmacist to the code team, and independent doublechecking of all code medications. Finally, role assignments were standardized and clarified by appointing a team nurse leader and assigning tasks to different members. Hospital residents now carry a specific code pager labeled with one particular role assignment, such as chest compressions. 

According to the researchers, in-situ simulation is a powerful technique to identify system weaknesses and promote successful solutions. The study was supported by AHRQ (HS16615). 

See "High-reliability emergency response teams in the hospital: Improving quality and safety using in-situ simulation training," by Derek S. Wheeler, M.D., M.M.M., Gary Geis, M.D., Elizabeth H. Mack, M.D., and others, in BMJ Quality & Safety 22, pp. 507-514, 2013.


Page last reviewed February 2014
Internet Citation: Simulation training in the hospital unit improves the quality of emergency response teams: Emergency Care. February 2014. Agency for Healthcare Research and Quality, Rockville, MD.


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