Simulation-based clinical systems testing for healtcare

Uroš Zafošnik, Zalika Klemenc Katiš, Davorin Markovič

Keywords: Simulation,quality, prepared


Lack of communication and cooperation among healthcare workers is one of the reasons for poor healthcare results and mistakes (Zwarenstein, Goldman, & Reeves, 2009). Interdisciplinary education with simulations reduces the number of mistakes in practice (Zwarenstein, Goldman, & Reeves, 2009; Pahor, 2014; Giles, 2016). The role of simulation center: performing education (SIMtrain); Designs, develops and incorporates technologies that make training increasingly realistic (SIM Engineer); Connecting with organizations and other important institutions for simulations in healthcare (SIM Networking); test new devices, policies and facilities in the simulation and identify potential threats, gaps and concerns (SIM test).


In CHC Ljubljana we use a structured approach to test complex systems named PREPARED. This tool contains 8 steps. (i. define the clinical problem; ii. appropriateness of the methodology; iii. learning outcomes; iv. engagement with teams; v. safety considerations and staff preparedness; vi. effective simulation design and delivery; vii. inclusive debrief with output; viii. disseminating learning).


The first protocol tested with this tool in CHC Ljubljana was “Red Alarm”. Red alarm is the activation of emergency teams. For performing the simulation an In Situ method was used. From January 2014 to April 2016 we have organized 180 simulations and 6 in situ.Prepared treatment protocols were excellent valued. Latent security risks, that have been identified, were: problems with equipment, high stress of some participants, uncoordinated team, doctor did not lead the team, too long response time and inadequate resuscitation algorithm.


We explore practice through simulation. We come to important data, what can hurt our patients. We obtain information, we see trends, expose areas that need more of our attention. With simulation, we discover areas, where improvements must be done. Otherwise it can be dangerous for the patient.

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