Simulation
Several latent risks were observed which would be amenable to interventions using simulation. Although training is seen as a weak intervention there is good evidence supporting improvements in team performance and skill retention using simulation-based education in a “low dose, high frequency” model . Whilst simulation training is regarded as standard in many CRFs (including OxCRF) to support staff in maintaining and developing skills for the management of emergency situations, we identified opportunities to better design and focus the scenarios to fit local practice, address skill gaps, focus on the most likely clinical situations that would be faced by staff (e.g. tailored to on-going or imminently opening studies) and for these to be offered more frequently than is routinely recommended by the UK CRF network.
Simulation is also a useful tool to test work systems, pathways and environments and has been used in a variety of clinical settings including Emergency Departments , Maternity Units and for major incident responses. The simulated transfer of a participant to the CT scanner in this study revealed several issues including the risk of transfer of pathogens to door surfaces and uncertainty around the exact route to be taken. Simulated walk throughs of tasks or procedures could be extended to reveal further potential safety threats and allow mitigations to be put in place pre-emptively.