Background: While many institutions train housestaff to mitigate hospital hazards, few have exploited the crucial concept of situational awareness (i.e. mindfulness of the patient environment) to teach patient safety. One method to promote situational awareness is through the embedding of safety and low-value care hazards into simulation-based training exercises.
Purpose: To assess incoming interns’ ability to identify safety and low-value hazards of hospitalization in an inpatient simulation designed to promote situational awareness.
Description: An inpatient simulation was constructed as a required component of GME orientation. Incoming interns were given ten minutes to independently review a mock chart and list all hazards they identified in a simulated hospital room. Eight safety hazards (e.g. penicillin allergy, wrong patient name) and four low-value hazards (e.g. unnecessary Foley catheter, unnecessary restraints) were included in the simulation based on Medicare Hospital Acquired Conditions, AHRQ Patient Safety Indicators, and Choosing Wisely recommendations. Interns completed a short survey on their prior safety training in medical school, and a follow-up survey one month after beginning internship. Simulation performance was measured by the percentage of total hazards identified correctly. T-tests were used to compare safety versus low-value hazards and to associate performance with prior safety training.
125 interns (100% of those eligible) participated in the simulation, representing thirteen specialties and sixty medical schools. 73.5% (89/121) had received prior safety training in medical school, and 50.0% (61/122) were satisfied with their prior safety training. The mean percentage of hazards correctly identified was 50.4% (median 50.0%, SD 11.8%). Interns identified significantly more safety hazards (mean 66.0%, SD 16.0%) than low-value hazards (mean 19.2%, SD 18.6%) (P < 0.001). There was no significant association between hazard identification and prior safety training or satisfaction with prior training. Interns entering less procedural-intensive specialties identified significantly more safety hazards (mean 69.1%, SD 16.9%) than those entering highly procedural-intensive specialties (mean 61.8%, SD 13.7%) (P = 0.012). One month post-simulation, 68.9% (82/119) of interns reported being more aware of how to identify hospital hazards, and 52.1% (62/119) had taken action to reduce a hazard that was included in the simulation.
Conclusions: Interns identified significantly more safety hazards than low-value hazards in the simulation. Prior safety training in medical school was not associated with interns’ ability to detect hazards, and satisfaction with prior training was low. The simulation resulted in increased situational awareness leading to hazard mitigation one month into internship. This highlights the need for experiential learning and situational-based training in medical education to improve safety and value of hospital care.