Simulation training for safer transitions of patients in fragmented healthcare systems

The authors' premise is that a safe organization is a cost- effective quality organization, wherein all stakeholders are trained to understand work processes and their role in them. Transitions of care are critical processes - failure leads to impaired safety, quality, and patient satisfaction, and increased costs. Improved transitions can be achieved through timely structured communication by harnessing information technology. Methods and tools to prompt this communication are needed. These must be designed to meet the needs of busy front-line staff for monitoring and improving their own systems. The authors have designed a published such a tool, known as the Transition Journal. In this paper the authors propose the use of this highly transferable tool for simulation training that can help inculcate leadership, systems thinking, communication, situational awareness, teamwork, consensus-based problem solving and decision making, as well as adaptive responsiveness. The tool is described, followed by proposed methods of simulation at individual and group levels using vignettes, and assessment of resulting individual and team competencies. Also described is an outline of the formative assessment of the approach. It is expected that this approach will enhance the 'meaningful use of electronic health records' called for in the USA.