Training Situational Awareness for Patient Safety in a Room of Horrors: An Evaluation of a Low-Fidelity Simulation Method

BACKGROUND: To protect patients from potential hazards of hospitalization, health care professionals need an adequate situational awareness. The Room of Horrors is a simulation-based method to train situational awareness that is little used in Switzerland. OBJECTIVES: This study aimed to evaluate (1) the performance of health care staff in identifying patient safety hazards, (2) the participants’ subjective experiences, and (3) the group interactions in Rooms of Horrors. METHODS: The study was conducted in 13 Swiss hospitals that implemented a Room of Horrors. Health care professionals participated as individuals or in groups and were asked to identify as many errors as possible within a certain time and to complete an evaluation questionnaire. Observations of group interactions were carried out in 8 hospitals. t Tests and χ(2) tests were used to examine differences in performance between participants solving the task alone versus in groups. RESULTS: Data of 959 health care professionals were included in the analysis. Single participants identified on average 4.7 of the 10 errors and additional 10 errors and hazards that were not part of the official scenario. However, they also overestimated their performance, with 58% feeling the errors to be easy to find. Group observations indicated that participants rarely reflected on possible consequences of the hazards for the patient or their daily work. Participants feedback to the method was very positive. CONCLUSIONS: Our findings suggest that the Room of Horrors is a popular and effective method to raise situational awareness for patient safety issues among health care staff. More attention should be given to debriefing after the experience and to benefits of interprofessional trainings.