title: Using simulation to investigate the impact of hours worked on task performance in an intensive care unit.
abstract: BACKGROUND
  Past studies have indicated a positive correlation between shift length and the rate of medical errors. In situ simulation is an innovative way to study issues in quality of care.
  
  
  OBJECTIVE
  To explore the use of in situ simulation as an investigative method by using it to examine the effects of work length on completion rate of and accuracy at critical care nursing tasks.
  
  
  METHODS
  Participants were drawn from the nursing staff in the pediatric intensive care unit and were assessed by using a high-fidelity pediatric simulator 3 times during a 12-hour shift. Data recorded included demographic information, time to task completion, and number of steps correctly performed per task.
  
  
  RESULTS
  Twenty-eight nurses with a mean of 5.5 years of experience participated. Each nurse cared for a mean of 1.4 patients per shift. A significant decrease (P < .001) of 5.5 minutes was noted in mean completion time across assessment intervals (from 17.9 to 13.3, to 12.4 min). No significant changes in accuracy were noted. Some accuracy issues seemed attributable to simulation artifact, whereas the use of simulation enabled greater standardization in other aspects of the study.
  
  
  CONCLUSIONS
  Critical care nurses take significantly less time to complete tasks at the end of their shift than at the beginning. This, coupled with a lack of change in accuracy of task completion over time, suggests that nursing performance of simple tasks may improve over the course of a 12-hour shift. Simulation can be an effective means to address some quality improvement issues.
authors.affiliation: Aaron W. Calhoun is an associate professor and Vicki L. Montgomery is a professor in the Department of Pediatrics, Division of Critical Care, University of Louisville School of Medicine, Louisville, Kentucky. Megan C. Boone is a clinical nurse specialist in the "Just For Kids" Critical Care Center, Kosair Children's Hospital, Louisville, Kentucky. Anna K. Dauer is a resident in general internal medicine at the St Louis University School of Medicine, St Louis, Missouri. Deborah R. Campbell is a quality improvement advisor for the Kentucky Hospital Engagement Network at the Kentucky Hospital Association, Louisville, Kentucky. aaron.calhoun@louisville.edu.
authors.forename: Aaron W
authors.initials: AW
authors.lastname: Calhoun
authors.affiliation: Aaron W. Calhoun is an associate professor and Vicki L. Montgomery is a professor in the Department of Pediatrics, Division of Critical Care, University of Louisville School of Medicine, Louisville, Kentucky. Megan C. Boone is a clinical nurse specialist in the "Just For Kids" Critical Care Center, Kosair Children's Hospital, Louisville, Kentucky. Anna K. Dauer is a resident in general internal medicine at the St Louis University School of Medicine, St Louis, Missouri. Deborah R. Campbell is a quality improvement advisor for the Kentucky Hospital Engagement Network at the Kentucky Hospital Association, Louisville, Kentucky.
authors.forename: Megan C
authors.initials: MC
authors.lastname: Boone
authors.affiliation: Aaron W. Calhoun is an associate professor and Vicki L. Montgomery is a professor in the Department of Pediatrics, Division of Critical Care, University of Louisville School of Medicine, Louisville, Kentucky. Megan C. Boone is a clinical nurse specialist in the "Just For Kids" Critical Care Center, Kosair Children's Hospital, Louisville, Kentucky. Anna K. Dauer is a resident in general internal medicine at the St Louis University School of Medicine, St Louis, Missouri. Deborah R. Campbell is a quality improvement advisor for the Kentucky Hospital Engagement Network at the Kentucky Hospital Association, Louisville, Kentucky.
authors.forename: Anna K
authors.initials: AK
authors.lastname: Dauer
authors.affiliation: Aaron W. Calhoun is an associate professor and Vicki L. Montgomery is a professor in the Department of Pediatrics, Division of Critical Care, University of Louisville School of Medicine, Louisville, Kentucky. Megan C. Boone is a clinical nurse specialist in the "Just For Kids" Critical Care Center, Kosair Children's Hospital, Louisville, Kentucky. Anna K. Dauer is a resident in general internal medicine at the St Louis University School of Medicine, St Louis, Missouri. Deborah R. Campbell is a quality improvement advisor for the Kentucky Hospital Engagement Network at the Kentucky Hospital Association, Louisville, Kentucky.
authors.forename: Deborah R
authors.initials: DR
authors.lastname: Campbell
authors.affiliation: Aaron W. Calhoun is an associate professor and Vicki L. Montgomery is a professor in the Department of Pediatrics, Division of Critical Care, University of Louisville School of Medicine, Louisville, Kentucky. Megan C. Boone is a clinical nurse specialist in the "Just For Kids" Critical Care Center, Kosair Children's Hospital, Louisville, Kentucky. Anna K. Dauer is a resident in general internal medicine at the St Louis University School of Medicine, St Louis, Missouri. Deborah R. Campbell is a quality improvement advisor for the Kentucky Hospital Engagement Network at the Kentucky Hospital Association, Louisville, Kentucky.
authors.forename: Vicki L
authors.initials: VL
authors.lastname: Montgomery
mesh_terms: D003198:Computer Simulation; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D008348:Manikins; D009741:Nursing Staff, Hospital; D010561:Personnel Staffing and Scheduling; D011446:Prospective Studies; D058996:Quality Improvement; D013997:Time Factors; D013996:Time and Motion Studies; D014940:Work Schedule Tolerance