In situ simulation as a tool for patient safety: a systematic review identifying how it is used and its effectiveness.

Background: In situ simulation is an emerging technique involving interdisciplinary teams working through simulated scenarios which replicate events encountered in healthcare institutions, particularly those which are either low frequency or associated with high risk to patients. Since it takes place in the clinical environment, it is ideally suited to improving patient safety outcomes. Objective: To identify and appraise all studies assessing contribution of in situ simulation to patient safety, identify gaps in knowledge and areas for future research, as well as suggesting strategies for maximising its impact on patient safety within an institution. Study selection: Three electronic databases (MEDLINE, PubMed and EMBASE) as well as the Cochrane Library were searched for articles relating to patient safety outcomes in in situ simulation. In addition a subject expert was approached to suggest any additional articles not identified by electronic searches. A total of 1795 abstracts were identified and screened, 35 full articles assessed for eligibility for inclusion and a total of 18 full articles included in the review after unsuitable articles were excluded. Conclusions: In situ simulation can improve real-life patient safety outcomes, with 2 studies demonstrating improved morbidity and mortality outcomes following initiation of in situ simulation. There is good evidence to suggest that its implementation leads to improved clinical skills, teamwork and observed behaviours. Additionally, it is ideally suited to detecting latent safety errors (errors identified within a scenario which, if they had occurred in real life, could have led to a degree of harm occurring to a patient). 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/.