title: The use of in situ simulation to evaluate teamwork and system organization during a pediatric dental clinic emergency.
abstract: BACKGROUND
  The purpose of this exercise was to use in situ simulation training to assess a pediatric dental clinic's emergency response protocol, specifically evaluating overall team and system process effectiveness as well as clinical performance.
  
  
  METHODS
  Two high-fidelity simulation scenarios were developed to evaluate an existing clinic-wide multidisciplinary emergency code response for a freestanding pediatric dentistry clinic. Participants included all clinic faculty, trainees (dental residents), and staff (dental assistant and clerks). Each scenario was based on a routine patient care issue experienced by the clinicians in practice. The scenarios were executed in a regular patient care room with all clinical faculty and staff. A facilitated group debrief occurred after each scenario to identify areas of vulnerability and process failures. Key issues were recorded and evaluated by the investigators to determine potential causes and solutions.
  
  
  RESULTS
  Primary areas of vulnerability identified included (1) team communication, (2) equipment availability, (3) dosing errors, and (4) role assignment. Failure to stock needed equipment and ineffective use of a preexisting radio system was noted. Participants reported that they learned from the experience and that they would revisit the current system and address these issues. Implementation of mandatory simulation training was the most immediate outcome from the experience.
  
  
  CONCLUSIONS
  In situ simulations can be leveraged to evaluate critical teamwork processes and system-based operations, both of which can impact dental team function during adverse patient events.
authors.affiliation: Medical Academic and Student Programs, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Brooks-Buza
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Fernandez
authors.forename: James P
authors.initials: JP
authors.lastname: Stenger
mesh_terms: D002648:Child; D003299:Cooperative Behavior; D003740:Dental Clinics / Q000458:organization & administration*; D004526:Efficiency; D004638:Emergency Treatment / Q000379:methods*; D006801:Humans; D007396:Internship and Residency; D010348:Patient Care Team / Q000458:organization & administration*; D010377:Pediatric Dentistry / Q000193:education*; D013335:Students, Dental; D014481:United States