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Acad Emerg Med. 2007 Dec;14(12):1141-8.

Multiple encounter simulation for high-acuity multipatient environment training.

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Department of Emergency Medicine, Brown Medical School, Providence, RI, USA.


Patient safety interventions for multitasking, multipatient, error-prone work settings such as the emergency department (ED) must improve assorted clinical abilities, specific cognitive strategies, and teamwork functions of the staff to be effective. Multiple encounter simulation scenarios explore and convey this specialized mental work-set through use of multiple high-fidelity medical simulation (SIM) manikins in realistic surroundings. Multipatient scenarios reflect the work situations being targeted yet have the benefit of scripted control and instructor guidance to advance specific educational objectives. The use of two or more SIM patients promotes the exploration not only of multiple distinct clinical issues but also of interdependent processes pervasive in EDs. Cascading shortages of time, personnel, equipment, and supplies are re-created, thereby replicating process limitations at various levels, in a safe environment in which compensatory actions and adaptive behaviors can be learned. Distinguishing features of multipatient exercises include 1) broadened educational scope and expanded indications for SIM application, 2) enhanced scenario complexity, 3) controlled exposure to high workload environments, 4) expanded communication requirements, and 5) increased potential for reflective learning. Widespread and effective training in well-replicated, carefully coordinated representations of complex multipatient work environments may strengthen educational interventions for personnel working in high acuity and work-overloaded settings such as the ED. The use of concurrent patient encounter SIM exercises to elicit calculated stressors and to foster compensatory staff behaviors is an educational advance toward this objective. The authors present SIM methodology using concurrent patient encounters to replicate these environments.

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