Effect of just-in-time simulation training on provider performance and patient outcomes for clinical procedures: a systematic review.

Background: Providing simulation training directly before an actual clinical procedure-or 'just-in-time' (JiT)-is resource intensive, but could improve both provider performance and patient outcomes.
Objectives: To assess the effects of JiT simulation training versus no JiT training on provider performance and patient complications following clinical procedures on patients. Study selection: We searched MEDLINE, Cochrane Library, CINAHL, PsycINFO, ERIC, ClinicalTrials.gov, simulation journals indexes and references of included studies during October 2014 for randomised trials, non-randomised trials and before-after studies comparing JiT simulation training versus no JiT training among providers performing clinical procedures. Findings were synthesised qualitatively. Findings: Of 1805 records screened, 8 studies comprising 3540 procedures and 1969 providers were eligible. 5 involved surgical procedures; the other 3 included paediatric endotracheal intubations, central venous catheter dressing changes, or infant lumbar puncture. Methodological quality was high. Of the 8 studies evaluating provider performance, 5 favoured JiT simulation training with 18-48% relative improvement on validated clinical performance scales, 16-20% relative reduction in surgical time and 12% absolute reduction in corrective prompts during central venous catheter dressing changes; 3 studies were equivocal with no improvement in intubation success, lumbar puncture success or urological surgery clinical performance scores. 3 studies evaluated patient complications; 1 favoured JiT simulation training with 45% relative reduction in central line-associated blood stream infections; 2 studies found no differences following intubation or laparoscopic nephrectomy. Conclusions: JiT simulation training improves provider performance, but currently available literature does not demonstrate a reduction in patient complications. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.