title: The use of in-situ simulation to improve safety in the plastic surgery office: a feasibility study.
abstract: OBJECTIVE
  Simulation-based interventions and education can potentially contribute to safer and more effective systems of care. We utilized in-situ simulation to highlight safety issues, regulatory requirements, and assess perceptions of safety processes by the plastic surgery office staff.
  
  
  METHODS
  A high-fidelity human patient simulator was brought to an office-based plastic surgery setting to enact a half-day full-scale, multidisciplinary medical emergency. Facilitated group debriefings were conducted after each scenario with special consideration of the principles of team training, communication, crisis management, and adherence to evidence-based protocols and regulatory standards. Abbreviated AHRQ Medical Office Safety Culture Survey was completed by the participants before and after the session.
  
  
  RESULTS
  The in-situ simulations had a high degree of acceptance and face validity according to the participants. Areas highlighted by the simulation sessions included rapid communication, delegation of tasks, location of emergency materials, scope of practice, and logistics of transport. The participant survey indicated greater awareness of patient safety issues following participation in simulation and debriefing exercises in 3 areas (P < 0.05): the need to change processes if there is a recognized patient safety issue (100% vs 75%), openness to ideas about improving office processes (100% vs 88%), and the need to discuss ways to prevent errors from recurring (88% vs 62%).
  
  
  CONCLUSIONS
  Issues of safety and regulatory compliance can be assessed in an office-based setting through the short-term (half-day) use of in-situ simulation with facilitated debriefing and the review of audiovisual recordings by trained facilities inspectors.
authors: Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Mass.
authors: Fred E
authors: FE
authors: Shapiro
authors: Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Mass.
authors: John B
authors: JB
authors: Pawlowski
authors: University of Massachusetts Memorial Medical Center, Worcester.
authors: Noah M
authors: NM
authors: Rosenberg
authors: Harvard Medical School, Brigham and Women's Hospital, Boston, Mass.
authors: Xiaoxia
authors: X
authors: Liu
authors: Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Mass.
authors: David M
authors: DM
authors: Feinstein
authors: Harvard Medical School, Brigham and Women's Hospital, Boston, Mass.
authors: Richard D
authors: RD
authors: Urman
keywords: in-situ simulation; office-based surgery; patient safety; plastic surgery; simulation training