Pause & Discuss – The Harms Involved in Improving Patient Safety

Many healthcare simulation programs are aimed at improving patient safety, and yet these programs also carry their own safety risks – to participants, and to the institutions and patients whose safety we are trying to improve. 

Ann Mullen joined us in this episode of Simulcast to discuss the Foundation for Simulation Safety – an initiative that she and Dan Raemer from Center for Medical Simulation in Boston have developed. 

Ann is the Simulation Center program manager at Newton-Wellesley Hospital in Massachusetts, and a nurse by clinical background. 

We discussed the categories of risks inherent in simulation – learner psychological and physical safety, and patient and institutional risks from fake medications, or unintended triggering of hospital responses to simulation activities. Stu Marshall and Cate McIntosh authored a chapter on this topic1 in the Nestel et al textbook recently reviewed on Simulcast. 

The Foundation website provides details of incidents, and access to labels designed to prevent these errors. Ann and Dan are also trying to use social media to promote this cause and to facilitate sharing stories of adverse events in sim and best practices in preventing them. Check out #keepsimsafe on Instagram and Twitter 

We discussed how perhaps we needed a reporting system for these incidents, and looked at the role of safety criteria in accreditation standards.    

Thanks to Ann for talking to us about an important topic. 



  1. Marshall, S. and McIntosh, C. (2017) Strategies for managing adverse events in healthcare simulations, in Healthcare Simulation Education: Evidence, Theory and Practice (edsD. Nestel, M. Kelly, B. Jolly and M. Watson), John Wiley & Sons, Ltd, Chichester, UK.

Feature image: Businessmen figurines in a maze game – Silver Bazel

6 thoughts on “Pause & Discuss – The Harms Involved in Improving Patient Safety

  • Yogesh

    Great podcast. I think maybe the risks are greater in in-situ simulation rather than in a dedicated and separate area/building which holds simulation sessions/program. Is that your experience too?

    • Victoria Brazil Post author

      Hi Yogesh. Thanks for your interest

      I think the risks in in-situ are more obvious, and we are attuned more to thinking about them. And something to consider in planning these sessions – needing enough strategies and human resources to mitigate risks.

      However as we discussed – we don’t really know where risks are greater/ more common – as there is no centralised data collection or sharing.
      We are likely blind to many risks in all forms of sim and even if aware – have inadequate mitigation strategies.

      Opened my eyes to more things to consider anyway !

      Thanks again

  • Asit Misra

    This is a serious issue which is often overlooked. It is an eye opener for me too. It is important for novice Simulation educators to have a Simulation safety checklist filled before they start any scenario. Simulation centres must think of having a Simulation safety committee to screen the current and proposed Simulation sessions for safety issues. While we are looking to develop simulation in developing countries it is the right time that they train their sim educators to consider the safety.
    In situ Simulation should be planned accordingly. I use a separate bag of consumables and drugs for them. As the session is over the contents are either discarded and safely disposed or kept back in the bag. Clear per briefing is important in Simulation. We must clearly disclose the participants that everything used in Simulation is not for human use.

  • Chad Epps

    Great piece on simulation safety Vic and Ann. I wanted to comment on one part of your discussion regarding accreditation standards. The SSH standards do address safety issues. The two specific criteria in the Core Standards are 2.d.i.2 which requires programs to have mechanisms to protect and address physical and psychological safety of individuals involved in simulation and 2.d.i.3 which requires programs to have mechanisms to appropriately separate simulation and actual patient care materials.
    I can also tell you it’s fairly routine for site reviewers to open drawers, closets, cabinets, etc to inspect for potential safety issues regarding simulation supplies.
    This is such an important topic and the SSH Standards agree! Best, Chad

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