Eric Schmidt, BA; Sara N. Goldhaber-Fiebert, MD; Lawrence A. Ho, MD; Kathryn M. McDonald, MM
Note: The Agency for Healthcare Research and Quality reviewed contract deliverables to ensure adherence to contract requirements and quality, and a copyright release was obtained from the Agency for Healthcare Research and Quality before the manuscript was submitted for publication.
Disclaimer: All statements expressed in this work are those of the authors and should not in any way be construed as official opinions or positions of Stanford University, the Agency for Healthcare and Quality, or the U.S. Department of Health and Human Services.
Financial Support: From the Agency for Healthcare and Quality, U.S. Department of Health and Human Services (contract HHSA-290-2007-10062I).
Potential Conflicts of Interest: Mr. Schmidt: Grant (money to institution): Agency for Healthcare Research and Quality. Ms. McDonald: Grant (money to institution): Agency for Healthcare Research and Quality. All other authors have no disclosures. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-2572.
Requests for Single Reprints: Kathryn M. McDonald, MM, Stanford University, 117 Encina Commons, Stanford, CA 94305-6019; e-mail, Kathryn.McDonald@stanford.edu.
Current Author Addresses: Mr. Schmidt and Ms. McDonald: Stanford Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University, 117 Encina Commons, Stanford, CA 94305-6019.
Drs. Goldhaber-Fiebert and Ho: Stanford University School of Medicine, Stanford University Hospital and Clinics, 291 Campus Drive, Stanford, CA 94305.
Author Contributions: Conception and design: E. Schmidt, S.N. Goldhaber-Fiebert, K.M. McDonald.
Analysis and interpretation of the data: E. Schmidt, S.N. Goldhaber-Fiebert, L.A. Ho, K.M. McDonald.
Drafting of the article: E. Schmidt, S.N. Goldhaber-Fiebert, L.A. Ho, K.M. McDonald.
Critical revision of the article for important intellectual content: E. Schmidt, S.N. Goldhaber-Fiebert, L.A. Ho, K.M. McDonald.
Final approval of the article: S.N. Goldhaber-Fiebert, K.M. McDonald.
Obtaining of funding: K.M. McDonald.
Administrative, technical, or logistic support: E. Schmidt, K.M. McDonald.
Collection and assembly of data: E. Schmidt, S.N. Goldhaber-Fiebert.
Simulation is a versatile technique used in a variety of health care settings for a variety of purposes, but the extent to which simulation may improve patient safety remains unknown. This systematic review examined evidence on the effects of simulation techniques on patient safety outcomes. PubMed and the Cochrane Library were searched from their beginning to 31 October 2012 to identify relevant studies. A single reviewer screened 913 abstracts and selected and abstracted data from 38 studies that reported outcomes during care of real patients after patient-, team-, or system-level simulation interventions. Studies varied widely in the quality of methodological design and description of simulation activities, but in general, simulation interventions improved the technical performance of individual clinicians and teams during critical events and complex procedures. Limited evidence suggested improvements in patient outcomes attributable to simulation exercises at the health system level. Future studies would benefit from standardized reporting of simulation components and identification of robust patient safety targets.
Table 1. Number of Studies, by Study Characteristics and Intervention Components
Table 2. Eleven Dimensions to Consider When Designing and Setting Up Simulation Exercises
Schmidt E, Goldhaber-Fiebert SN, Ho LA, et al. Simulation Exercises as a Patient Safety Strategy: A Systematic Review. Ann Intern Med. 2013;158:426–432. doi: https://doi.org/10.7326/0003-4819-158-5-201303051-00010
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Published: Ann Intern Med. 2013;158(5_Part_2):426-432.
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