Changes in performance during repeated in-situ simulations with different cases

INTRODUCTION: The aim was to describe changes in the performance of clinical actions, during repeated in-situ simulations with different cases, by teams of healthcare professionals with different experiences of the systematic clinical observation of deteriorating patients, after an introduction to the Airways, Breathing, Circulation, Disability, Environment/Exposure (ABCDE) approach. METHODS: A descriptive observational study was conducted of repeated in-situ simulations using a patient simulator (SimMan 3G), carried out by teams in a public nursing home (NH, least experienced), an out-of-hours general practice (OOH-GP) service and a hospital emergency department (ED, most experienced). The cases had similar clinical presentations but different underlying diagnoses unknown to the teams. Four blinded clinical experts independently assessed the simulations on the basis of transcripts, providing comments, an overall score and scores for the clinical actions. RESULTS: The assessors commented on the overall lack of a systematic ABCDE approach in the NH and OOH-GP in all simulations, while the comments for the ED concerned the choice of treatment. Across the teams, the overall score was highest in the first simulation and second highest in the third simulation. The team in the NH received low overall scores for all simulations, but the last simulation received markedly better scores on the clinical actions. The teams in the OOH-GP and ED had no such clear pattern in the scores for clinical actions and thus no indications of improvement with repeated simulations. CONCLUSION: The observation in this study was that the overall assessment by the blinded assessors showed no consistent improvement in clinical actions from repeated in-situ simulations, and the teams did not seem to adhere to the ABCDE approach throughout the simulations. This indicates that the teams were not able to apply their newly acquired experiences of using the ABCDE approach from one case to another, different case.