The Impact of Multidisciplinary In Situ Simulation-Based Team Training in the Operating Room on Patient Outcomes: A Scoping Review

Abstract

A high-risk acute care area, such as the operating room (OR), requires seamless teamwork for the provision of safe care due to its fast-paced nature. Any breakdown in teamwork in this high-stakes setting could lead to adverse patient outcomes. Simulation-based team training strategies adopted from the principles of Crew Resource Management (CRM) from the aviation industry are a prominent modality used to train multispecialty teams in the OR. While sufficient evidence in the literature highlights the positive behavioral attitudes and improved non-technical skills of the OR teams, this review aims to examine and assess the impact of interprofessional point-of-care simulation training in the OR on patient safety and clinical outcomes. A scoping review methodology was employed for comprehensive and iterative evidence research across five electronic databases. Methodological rigor was assessed using the Quality Assessment Tool for Studies with Diverse Designs, followed by thematic analysis of the extracted data and systematic mapping of the literature. A total of 110 papers were screened, with 35 full-text articles assessed for eligibility. Twelve studies were included in the review with the identification of three recurring themes highlighting the impact of in situ simulation training in the OR on healthcare teams, clinical outcomes, and patient safety: 1) impact on team behavior, attitude, and non-technical skills; 2) identification of latent safety threats; and 3) clinical outcomes, morbidity, and mortality. Simulation training in in situ settings offers multidisciplinary OR teams an opportunity to practice high-risk procedures in a controlled environment. It allows teams to overcome organizational barriers through the development of human factors and non-technical skills among healthcare professionals and identify latent safety threats to proactively address potential causes of error and harm, reflecting a constructive impact on patient safety. However, more research is warranted to demonstrate the direct influence of in situ simulation-based OR team training on clinical outcomes through standardized assessment tools, prompting initiatives aimed at improvement, and advocating for the incorporation of in situ simulation as a valuable component in the quality improvement cycle within the healthcare sector.