Table 1 Objectives and outcome measures of the studies in the scoping review
First author / Year | Objectives | Participants Setting | ISS length and frequency Announced / unannounced (if reported) | Outcomes: Clinical knowledge, technical or procedural skills and response times | Outcomes: Non-technical skills and teamwork behaviours | Outcomes: System and process design, LST detection |
|---|---|---|---|---|---|---|
Amiel 2016 [48] | ISS to evaluate and to train trauma teams | Interprofessional trauma teams Hospital | 45-min ISS before and after a training intervention | Advanced Trauma Life Support skills, safety | Teamwork, communication | |
Barbeito 2015 [36] | Monitor cardiac arrest response process for hazards and defects. Detect opportunities for system optimisation | Interprofessional CPR teams Hospital locations | 72 ISS cardiac arrest sessions over 3 years Unannounced | Teamwork and culture hazards and defects | Environmental, human machine Interface and policy hazards and defects | |
Ben-Ari 2018 [38] | improve safer practice of ED sedation by paediatricians | Paediatricians Paediatric ED | ISS with debrief followed by a second ISS (2–9 weeks later). Unannounced | Patient safety task performance related to sedation | ||
Bender 2011 [6] | TESTPILOT implementation to demonstrate improved system readiness and staff preparedness | Interprofessional teams New neonatal Intensive Care Unit | 30-min ISS over 4 days | System readiness and identification of LSTs | ||
Brandstorp 2016 [8] | Explore the local learning processes and to improve ISS team training in the primary care emergency teams with a focus on interaction | Primary care Interprofessional teams Rural Primary Care settings | Monthly, one-day training sessions | Participants reported understanding of communication and developed local procedures | ||
Chen 2017 [66] | Assess the readiness of a new department | Interprofessional teams Hospital facility | ISS over 4 phases in 3 h Unannounced | Identification of process and system issues | ||
Fialkow 2014 [39] | Development, content validation, and implementation of a post-partum haemorrhage (PPH) ISS | Interprofessional teams Obstetric units | Two-hour training with a 20-min ISS followed by a debrief Unannounced | Participants perceived benefit of the ISS for managing clinical emergencies | Participants perceived benefit of ISS for teamwork learning | |
Geis 2011 [52] | Assess the Safety of New Healthcare Teams and New Facilities | Interprofessional teams Emergency department | Two 8-h ISS scenarios | Clinical proficiencies | Teamwork behaviours | Identification of LSTs |
Gibbs 2018 [53] | Mitigate an Outbreak of Methicillin-Resistant Staphylococcus aureus (MRSA) | Interprofessional teams Neonatal Intensive Care Unit | 30-min ISS over 2 weeks | Compliance with hand hygiene, knowledge about infection control. MRSA rates of infection | Diagnose and correct LSTs | |
Gundrosen 2014 [59] | Asses the feasibility of ISS and assessing non-technical skills | Nurses Intensive care | one-hour training followed by ISS assessment | Team competence and non-technical skills | ||
Härgestam 2016 [49] | Investigate factors associated with the time taken to decide to go to surgery | Interprofessional teams Emergency departments | Single ISS with 16 trauma teams | Time taken to decide to go to surgery (seconds) | Closed loop communication | |
Herbers 2016 [40] | increase confidence levels and improve nursing performance during emergencies | Nursing staff Medical and vascular surgical progressive care | Regular ISS conducted over a 2-year period | Response times and nurses’ confidence | ||
Jung 2016 [41] | Increase knowledge of how to perform during a disaster, improve skills and communication | Interprofessional teams Emergency departments | Knowledge, skills and | Participants’ communication scores | ||
Kelsey 2016 [4] | Understand how to safely prioritize a difficult care situation and manage workload | Nursing staff Inpatient medical-surgical nursing unit | Over 12 h with 3 short ISS embedded Unannounced | Identification of additional educational needs. Nurses’ knowledge and comfort | ||
Knight 2014 [58] | Resuscitation Team Training to improve survival to discharge and code team performance | Interprofessional teams Children’s hospital | Monthly ISS over 6 months Unannounced | Survival rates, morbidity, team performance | ||
Kobayashi 2012 [54] | ISS to improve safety of Emergency department procedural sedation (EDPS) | Physicians Trauma centre | 10 ISS scenarios over 3 months | Skills confidence levels | ||
Kobayashi 2013 [68] | Determine performance characteristics of a telemetry system | Interprofessional teams Emergency department | ISS over three 2-week periods (pre-post intervention) | Simulated arrhythmia detection | System performance | |
Kurosawa 2014 [42] | Feasibility and effectiveness of ISS Paediatric Advanced Life Support training for recertification | Nurses and respiratory therapists Paediatric Intensive Care Unit | Six 30-min ISS over 6 months Announced | Clinical performance scores | Behavioural scores | |
Lavelle 2017 [5] | Improve knowledge, confidence, and attitudes towards managing medical deterioration | Interprofessional teams Mental health wards | Eight half-day sessions (weekly) Staff aware that training was taking place | Knowledge, confidence and attitudes managing medical deterioration | Understanding effective communication, self-reflection, team working | |
Lutgendorf 2017 [57] | Develop and implement a comprehensive, high fidelity, obstetric simulation | Interprofessional teams Obstetric unit | 2-day period, with 8 ISS per day | Comfort levels managing obstetric emergencies. Clinical outcomes and response times | Perceived benefit on teamwork and communication | |
Marshall 2015 [46] | Evaluate ISS and team training for PPH | Interprofessional teams Obstetric units (urban and rural communities) | ISS with debrief and training – repeated 9–12 months later | Response times—recognition of PPH, administer medication, performance of uterine massage | ||
Medwid 2015 [64] | ISS to identify LSTs, improve layout and workflow, orient staff and decrease stress during the first few weeks of opening | Interprofessional teams Emergency department | 15 ISS throughout the day | Orientation, identification of LSTs | ||
Miller 2012 [60] | ISS to improve perinatal safety | Interprofessional obstetric and neonatal staff Six hospitals | 35 ISS events of obstetric emergencies | Teamwork behaviours | ||
O’Leary 2014 [55] | Identify suboptimal care during simulated scenarios and identify the potential causation factors | Interprofessional teams Emergency department and operating theatre | 73 ISS over 9 months | Knowledge and clinical skill deficits, drug choice and doses, advanced airway and ventilation, intravenous fluids and recognition of the deteriorating patient | Leadership, communication, planning, situational awareness | Causes of suboptimal care |
Patterson 2013 [50] | ISS to promote identification of LSTs and systems issues | Interprofessional teams Emergency departments | 90 ISS over 1 year. 10-min ISS and 10-min debrief | Perceived values of ISS on learning outcomes Clinical impact | Teamwork scores | Identification of LSTs |
Rubio-Gurung 2014 [43] | To determine whether ISS training improved neonatal resuscitation | Interprofessional maternity teams Maternity units | 4-h training: Two 10-min ISS and debrief | Technical skills | Teamwork score | Hazardous events |
Siegel 2015 [44] | Assess emergency department procedural sedation | Senior emergency medicine residents Emergency department | 2 ISS scenarios | Safety practices | Performance skills | |
Sørensen 2014 [45] | Impact and participant perception of ISS | Interprofessional maternity teams Maternity unit | ISS drills obstetric emergencies Unannounced | Participant perception of ISS: stress, anxiety perceived benefit | ||
Sørensen 2015 [61] | Effect of ISS versus off-site simulation on knowledge, patient safety attitude, stress, motivation, team performance and organisational impact | Interprofessional maternity teams Maternity units | 18–26 min ISS followed by a debrief Announced | Knowledge scores and patient safety attitude | Stress measurements, motivation and teamworking | |
Thelian 2017 [56] | Evaluate the long-term impact of ongoing regular team training on hospital response to deteriorating ward patients | Interprofessional teams Paediatric hospital | Weekly team training with ISS lasting 2-h | Patient outcomes and admissions (pre/post intervention) | ||
Ventre 2014 [63] | Evaluate Operational Readiness of a Children’s Hospital-Based Obstetrics Unit | Interprofessional teams Obstetric unit | 3 ISS scenarios across several weeks | Interprofessional communication | Identification of operational deficiencies and system issues | |
Wheeler 2013 [62] | ISS to improve quality and safety | Interprofessional teams Children’s hospitals | Regular 10-min ISS and 10-min debrief | Participants’ knowledge | Teamwork behaviours | Identification of LSTs |
Yager 2016 [47] | ISS to identify latent inefficiencies and allow rapid intervention testing to improve performance | Interprofessional teams Paediatric intensive care unit | 12 20-min ISS paediatric emergencies over one year (40 min debrief) | Response times following inefficiencies identified during ISS and implementing improvements | Process inefficiencies | |
Yajamanyam 2015 [65] | In situ simulation as a quality improvement initiative | Interprofessional teams Paediatric emergency department and neonatal unit | 29 45-min ISS across the units | Identification of LSTs | ||
Zimmerman 2015 [51] | Development, implementation and impact of an ISS team and resuscitation training program | Interprofessional teams Children’s hospital units | Regular monthly ISS and debrief | Learning needs assessment | Communication, leadership | LSTs and system changes |