Using Simulation to Improve Systems-Based Practices

Jt Comm J Qual Patient Saf. 2017 Sep;43(9):484-491. doi: 10.1016/j.jcjq.2017.05.006. Epub 2017 Jul 19.


Background: Ensuring the safe, effective management of patients requires efficient processes of care within a smoothly operating system in which highly reliable teams of talented, skilled health care providers are able to use the vast array of high-technology resources and intensive care techniques available. Simulation can play a unique role in exploring and improving the complex perioperative system by proactively identifying latent safety threats and mitigating their damage to ensure that all those who work in this critical health care environment can provide optimal levels of patient care.

Methods: A panel of five experts from a wide range of institutions was brought together to discuss the added value of simulation-based training for improving systems-based aspects of the perioperative service line. Panelists shared the way in which simulation was demonstrated at their institutions. The themes discussed by each panel member were delineated into four avenues through which simulation-based techniques have been used.

Results: Simulation-based techniques are being used in (1) testing new clinical workspaces and facilities before they open to identify potential latent conditions; (2) practicing how to identify the deteriorating patient and escalate care in an effective manner; (3) performing prospective root cause analyses to address system weaknesses leading to sentinel events; and (4) evaluating the efficiency and effectiveness of the electronic health record in the perioperative setting.

Conclusion: This focused review of simulation-based interventions to test and improve components of the perioperative microsystem, which includes literature that has emerged since the panel's presentation, highlights the broad-based utility of simulation-based technologies in health care.

Publication types

  • Review

MeSH terms

  • Attitude of Health Personnel
  • Clinical Deterioration
  • Communication
  • Delivery of Health Care / organization & administration*
  • Delivery of Health Care / standards
  • Efficiency, Organizational
  • Electronic Health Records / organization & administration
  • Humans
  • Medical Errors / prevention & control
  • Patient Safety
  • Perioperative Care / standards*
  • Prospective Studies
  • Quality Improvement / organization & administration*
  • Safety Management / organization & administration*
  • Simulation Training / organization & administration*
  • Workflow