Adverse events in obstetrics threaten the safety of both maternal and infant patients. This study identified a significant reduction in malpractice claims among obstetrician-gynecologists after participation in simulation training focused on team training and crisis management.

Although simulation training heightens the learning experience, the potential for artificial medication labels, liquid, and equipment to be incorporated into active inventory is a potential hazard. The authors, directors of the Foundation for Healthcare Simulation Safety, call for heightened attention to this emerging problem. They recommend use of failure mode and effect analysis, labeling materials specifically for educational use, and controlling access to training materials as strategies to reduce the potential for simulation-related equipment hazards.

Simulation has been advocated as a way to create a safe space to learn from error. This commentary describes why simulation exercises should define expectations, commit to a "fiction contract" with participants, be logistically realistic, and support psychological safety. The authors suggest that these elements will encourage open dialogue about the mistakes that arise during the exercise.

Obstetricians and labor nurses who were given a best practices guideline performed better in a standardized disclosure-and-apology discussion simulation than colleagues who were provided as much time as they thought was needed to prepare. Similar cognitive aids may help clinicians faced with disclosing adverse events to patients.

Simulation training for operating room (OR) teams is an effective tool for improving teamwork and communication, but can be resource intensive and expensive. Due to these barriers, most simulation programs have only included trainees. For this study, a malpractice insurer provided the financial and administrative resources necessary to develop a standardized OR simulation training curriculum that involved active participation of attending surgeons and anesthesiologists. The group provided modest compensation for physicians' time and achieved wide participation. This teamwork curriculum covered principles of communication, assertiveness, and use of the WHO surgical safety checklist. Nearly all (93%) participants thought that the training would help them provide safer care. Dr. David Gaba discussed simulation training in a recent AHRQ WebM&M interview.

… feedback to clinicians after an error. … Rudolph J, Raemer D, Shapiro J. We know what they did wrong, but not …

This study observed videotaped performances to describe the team behaviors of anesthesiologists and obstetricians, particularly around their communication styles.

Seminal studies and a Joint Commission Sentinel Event Alert have highlighted the importance of engaged leadership in promoting a culture of safety. This study discusses an innovative approach for immersing both clinical and non-clinical management in patient safety through team-based problem solving exercises, where groups of managers were required to respond to a simulated safety threat in real time. Participants found the simulated scenarios to be very effective at illustrating sharp end safety issues and promoting the importance of multidisciplinary teamwork in improving patient safety. A related study also found that formal teamwork training for hospital managers positively impacted safety leadership behaviors.

The authors describe a behavior-based tool to measure clinicians' teamwork and communication skills.

The authors present a debriefing approach based on behavioral sciences that focuses on self-reflection and disclosure of the instructor's judgments.

… of emergency care. … Risser DT, Rice MM, Salisbury ML, Simon R, Jay GD, Berns SD. The potential for improved …

Using crew resource management (CRM), behavioral principles developed in aviation, this study reports on applying similar teamwork training in hospital emergency departments. After developing and implementing a modified training curriculum, investigators measured its effectiveness by addressing three outcomes: team behaviors, attitudes and opinions, and emergency department performance. The prospective study used physician-nurse teams for training and observation of a broadly defined range of clinical errors. Authors concluded that teamwork training based on CRM led to successful improvements in specific teamwork behaviors, reduced clinical errors, and enhanced staff attitudes toward teamwork.