Simulación clínica in situ en servicios de emergencia: implicancias para la seguridad del paciente
Contenido principal del artículo
Keywords
Simulación Clínica, Servicios Médicos de Urgencia,, Seguridad del Paciente, Capacitación del Personal en Salud
Resumen
La simulación clínica in situ es una estrategia de capacitación que se desarrolla directamente en entornos clínicos reales, utilizando el equipamiento habitual del servicio. Esta modalidad busca fortalecer las competencias del personal de salud, mejorar la respuesta ante situaciones críticas y optimizar la seguridad del paciente. Al replicar escenarios realistas en el lugar de trabajo, se facilita la transferencia de habilidades a la práctica clínica y se promueve la comunicación efectiva y el trabajo en equipo, factores clave para una atención segura. No obstante, su implementación enfrenta barreras como la falta de estandarización, la sobrecarga laboral, la escasa disponibilidad de tiempo y recursos. La incorporación de tecnologías innovadoras, como la realidad virtual y aumentada, representa una oportunidad para potenciar la efectividad de estas intervenciones formativas. Para superar estos desafíos, se recomienda fortalecer el liderazgo institucional, capacitar a instructores en metodologías andragógicas, optimizar los recursos disponibles y monitorear el impacto de la simulación en la seguridad del paciente.
Citas
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3. Eppich W, Reedy G. Advancing healthcare simulation research: innovations in theory, methodology, and method. Adv Simul. 2022 Dec 1;7(1):1-4. Disponible en: https://advancesinsimulation.biomedcentral.com/articles/10.1186/s41077-022-00219-y
4. Clapper TC. In Situ and Mobile Simulation: Lessons Learned Authentic and Resource Intensive. Clin Simul Nurs. 2013 Nov 1;9(11):e551-7.
5. McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Does Simulation-Based Medical Education With Deliberate Practice Yield Better Results Than Traditional Clinical Education? A Meta-Analytic Comparative Review of the Evidence. Acad Med. 2011 Jun;86(6):706-11.
6. Hung K, Santana C, Thurman Johnson C, Owen N, Hessels AJ. Effectiveness of In-situ Simulation on Clinical Competence for Nurses: A Systematic Review. Clin Simul Nurs. 2024 Feb 1;87:101502.
7. Blais S, Marceau M, Lavoie S, Ledoux I. Description of In Situ Simulation Activities in Critical Care Units of Québec (Canada). Clin Simul Nurs. 2023 Dec 1;85:101471.
8. Diaz-Navarro C, Armstrong R, Charnetski M, Freeman KJ, Koh S, Reedy G, et al. Global consensus statement on simulation-based practice in healthcare. Adv Simul. 2024 Dec 1;9(1):1-10. Disponible en: https://advancesinsimulation.biomedcentral.com/articles/10.1186/s41077-024-00288-1
9. Rollison S, Blessing R, Kuszajewski ML, Muckler VC. In Situ Simulation to Improve Management of In-Hospital Strokes: Unexpected Challenges. Clin Simul Nurs. 2018 Nov 1;24:30-4.
10. Adcock S, Kuszajewski ML, Dangerfield C, Muckler VC. Optimizing Nursing Response to In-Hospital Cardiac Arrest Events Using In Situ Simulation. Clin Simul Nurs. 2020 Dec 1;49:50-7.
11. Agency for Healthcare Research and Quality. Simulation Research. 2024. Disponible en: https://www.ahrq.gov/patient-safety/resources/simulation.html
12. Hazwani T, Hamam H, Caswell A, Madkhaly A, Al Saif S, Al Hassan Z, et al. Proactive patient safety: enhancing hospital readiness through simulation-based clinical systems testing and healthcare failure mode and effect analysis. Adv Simul. 2024 Dec 1;9(1):1-12. Disponible en: https://advancesinsimulation.biomedcentral.com/articles/10.1186/s41077-024-00298-z
13. Patterson MD, Blike GT, Nadkarni VM. In Situ Simulation: Challenges and Results. Advances in Patient Safety: New Directions and Alternative Approaches (Vol 3: Performance and Tools). 2011 Jan 21. Disponible en: http://europepmc.org/books/NBK43682
14. Tseng LP, Hou TH, Huang LP, Ou YK. Effectiveness of applying clinical simulation scenarios and integrating information technology in medical-surgical nursing and critical nursing courses. BMC Nurs. 2021 Dec 1;20(1):1-14. Disponible en: https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-021-00744-7
15. Platt A, Allan J, Leader C. An Exploration of the Use of Deliberate Practice in Team-Centered Healthcare Simulation-Based Education: An Integrative Review. Clin Simul Nurs. 2024 Sep 1;94:101584.
16. Diaz-Navarro C, Jones B, Pugh G, Moneypenny M, Lazarovici M, Grant DJ. Improving quality through simulation; developing guidance to design simulation interventions following key events in healthcare. Adv Simul. 2024 Dec 1;9(1):1-5. Disponible en: https://advancesinsimulation.biomedcentral.com/articles/10.1186/s41077-024-00300-8
17. Davari F, Nasr Isfahani M, Atighechian A, Ghobadian E. Optimizing emergency department efficiency: a comparative analysis of process mining and simulation models to mitigate overcrowding and waiting times. BMC Med Inform Decis Mak. 2024 Dec 1;24(1):295. Disponible en: https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-024-02704-y
18. Lamé G, Dixon-Woods M. Using clinical simulation to study how to improve quality and safety in healthcare. BMJ Simul Technol Enhanc Learn. 2020 Mar 1;6(2):87-94. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32133154/
19. Spurr J, Gatward J, Joshi N, Carley SD. Top 10 (+1) tips to get started with in situ simulation in emergency and critical care departments. Emerg Med J. 2016 Jul 1;33(7):514-6. Disponible en: https://pubmed.ncbi.nlm.nih.gov/26969169/
20. Jee M, Murphy E, Umana E, O’connor P, Khamoudes D, Mcnicholl B, et al. Exploring barriers and enablers to simulation-based training in emergency departments: an international qualitative study (BEST-ED Study). BMJ Open. 2023 Sep 5;13(9). Disponible en: https://pubmed.ncbi.nlm.nih.gov/37669835/
21. Verhagen MJ, de Vos MS, Smaggus A, Hamming JF. Measuring What Matters at Morbidity and Mortality Conferences: A Scoping Review of Effectiveness Measures. J Patient Saf. 2022 Jun 1;18(4):E760-8. Disponible en: https://pubmed.ncbi.nlm.nih.gov/35617601/
22. Murakami T, Yamamoto A, Hagiya H, Obika M, Mandai Y, Miyoshi T, et al. The effectiveness of simulation-based education combined with peer-assisted learning on clinical performance of first-year medical residents: a case-control study. BMC Med Educ. 2023 Dec 1;23(1):1-10. Disponible en: https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-023-04798-w
23. Salas E, Reyes DL, McDaniel SH. The science of teamwork: Progress, reflections, and the road ahead. Am Psychol. 2018 May 1;73(4):93-600.
24. Carne B, Kennedy M, Gray T. Review article: Crisis resource management in emergency medicine. Emerg Med Australas. 2012 Feb 1;24(1):7-13. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1742-6723.2011.01495.x
25. Weile J, Nebsbjerg MA, Ovesen SH, Paltved C, Ingeman ML. Simulation-based team training in time-critical clinical presentations in emergency medicine and critical care: a review of the literature. Adv Simul. 2021 Dec 1;6(1):1-12. Disponible en: https://advancesinsimulation.biomedcentral.com/articles/10.1186/s41077-021-00154-4
26. Jeong J, Lee SW, Kim WY, Han KS, Kim SJ, Kang H. Development and validation of a scoring system for mortality prediction and application of standardized W statistics to assess the performance of emergency departments. BMC Emerg Med. 2021 Dec 1;21(1):1-9. Disponible en: https://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-021-00466-8
27. Patterson MD, Geis GL, LeMaster T, Wears RL. Impact of multidisciplinary simulation-based training on patient safety in a paediatric emergency department. BMJ Qual Saf. 2013 May 1;22(5):383. Disponible en: http://qualitysafety.bmj.com/content/22/5/383.abstract
28. Petrosoniak A, Ryzynski A, Lebovic G, Woolfrey K. Cricothyroidotomy in situ simulation curriculum (CRIC Study). Simul Healthc. 2017 Apr 1;12(2):76-82. Disponible en: https://journals.lww.com/simulationinhealthcare/fulltext/2017/04000/cricothyroidotomy_in_situ_simulation_curriculum.3.aspx
29. Naemi A, Schmidt T, Mansourvar M, Naghavi-Behzad M, Ebrahimi A, Wiil UK. Machine learning techniques for mortality prediction in emergency departments: a systematic review. BMJ Open. 2021 Nov 2;11(11). Disponible en: https://pubmed.ncbi.nlm.nih.gov/34728454/
30. Rosen MA, Salas E, Silvestri S, Wu TS, Lazzara EH. A measurement tool for simulation-based training in emergency medicine: the simulation module for assessment of resident targeted event responses (SMARTER) approach. Simul Healthc. 2008 Sep;3(3):170-9. Disponible en: https://pubmed.ncbi.nlm.nih.gov/19088661/
31. Geis GL, Pio B, Pendergrass TL, Moyer MR, Patterson MD. Simulation to assess the safety of new healthcare teams and new facilities. Simul Healthc. 2011 Jun;6(3):125-33. Disponible en: https://journals.lww.com/simulationinhealthcare/fulltext/2011/06000/simulation_to_assess_the_safety_of_new_healthcare.1.aspx
32. Davis D, Warrington SJ. Simulation Training and Skill Assessment in Emergency Medicine. StatPearls. 2023 May 1. Disponible en: https://www.ncbi.nlm.nih.gov/sites/books/NBK557695/
33. Vozenilek J, Wang E, Kharasch M, Anderson B, Kalaria A. Simulation-based morbidity and mortality conference: new technologies augmenting traditional case-based presentations. Acad Emerg Med. 2006 Jan;13(1):48-53. Disponible en: https://pubmed.ncbi.nlm.nih.gov/16365338/
34. Ju M, Bochatay N, Robertson K, Frank J, O’Brien B, van Schaik S. From ideal to real: a qualitative study of the implementation of in situ interprofessional simulation-based education. BMC Med Educ. 2022 Dec 1;22(1):1-11. Disponible en: https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-022-03370-2
2. Backhouse A, Ogunlayi F. Quality improvement into practice. BMJ. 2020 Mar 31;368. Disponible en: https://www.bmj.com/content/368/bmj.m865
3. Eppich W, Reedy G. Advancing healthcare simulation research: innovations in theory, methodology, and method. Adv Simul. 2022 Dec 1;7(1):1-4. Disponible en: https://advancesinsimulation.biomedcentral.com/articles/10.1186/s41077-022-00219-y
4. Clapper TC. In Situ and Mobile Simulation: Lessons Learned Authentic and Resource Intensive. Clin Simul Nurs. 2013 Nov 1;9(11):e551-7.
5. McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Does Simulation-Based Medical Education With Deliberate Practice Yield Better Results Than Traditional Clinical Education? A Meta-Analytic Comparative Review of the Evidence. Acad Med. 2011 Jun;86(6):706-11.
6. Hung K, Santana C, Thurman Johnson C, Owen N, Hessels AJ. Effectiveness of In-situ Simulation on Clinical Competence for Nurses: A Systematic Review. Clin Simul Nurs. 2024 Feb 1;87:101502.
7. Blais S, Marceau M, Lavoie S, Ledoux I. Description of In Situ Simulation Activities in Critical Care Units of Québec (Canada). Clin Simul Nurs. 2023 Dec 1;85:101471.
8. Diaz-Navarro C, Armstrong R, Charnetski M, Freeman KJ, Koh S, Reedy G, et al. Global consensus statement on simulation-based practice in healthcare. Adv Simul. 2024 Dec 1;9(1):1-10. Disponible en: https://advancesinsimulation.biomedcentral.com/articles/10.1186/s41077-024-00288-1
9. Rollison S, Blessing R, Kuszajewski ML, Muckler VC. In Situ Simulation to Improve Management of In-Hospital Strokes: Unexpected Challenges. Clin Simul Nurs. 2018 Nov 1;24:30-4.
10. Adcock S, Kuszajewski ML, Dangerfield C, Muckler VC. Optimizing Nursing Response to In-Hospital Cardiac Arrest Events Using In Situ Simulation. Clin Simul Nurs. 2020 Dec 1;49:50-7.
11. Agency for Healthcare Research and Quality. Simulation Research. 2024. Disponible en: https://www.ahrq.gov/patient-safety/resources/simulation.html
12. Hazwani T, Hamam H, Caswell A, Madkhaly A, Al Saif S, Al Hassan Z, et al. Proactive patient safety: enhancing hospital readiness through simulation-based clinical systems testing and healthcare failure mode and effect analysis. Adv Simul. 2024 Dec 1;9(1):1-12. Disponible en: https://advancesinsimulation.biomedcentral.com/articles/10.1186/s41077-024-00298-z
13. Patterson MD, Blike GT, Nadkarni VM. In Situ Simulation: Challenges and Results. Advances in Patient Safety: New Directions and Alternative Approaches (Vol 3: Performance and Tools). 2011 Jan 21. Disponible en: http://europepmc.org/books/NBK43682
14. Tseng LP, Hou TH, Huang LP, Ou YK. Effectiveness of applying clinical simulation scenarios and integrating information technology in medical-surgical nursing and critical nursing courses. BMC Nurs. 2021 Dec 1;20(1):1-14. Disponible en: https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-021-00744-7
15. Platt A, Allan J, Leader C. An Exploration of the Use of Deliberate Practice in Team-Centered Healthcare Simulation-Based Education: An Integrative Review. Clin Simul Nurs. 2024 Sep 1;94:101584.
16. Diaz-Navarro C, Jones B, Pugh G, Moneypenny M, Lazarovici M, Grant DJ. Improving quality through simulation; developing guidance to design simulation interventions following key events in healthcare. Adv Simul. 2024 Dec 1;9(1):1-5. Disponible en: https://advancesinsimulation.biomedcentral.com/articles/10.1186/s41077-024-00300-8
17. Davari F, Nasr Isfahani M, Atighechian A, Ghobadian E. Optimizing emergency department efficiency: a comparative analysis of process mining and simulation models to mitigate overcrowding and waiting times. BMC Med Inform Decis Mak. 2024 Dec 1;24(1):295. Disponible en: https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-024-02704-y
18. Lamé G, Dixon-Woods M. Using clinical simulation to study how to improve quality and safety in healthcare. BMJ Simul Technol Enhanc Learn. 2020 Mar 1;6(2):87-94. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32133154/
19. Spurr J, Gatward J, Joshi N, Carley SD. Top 10 (+1) tips to get started with in situ simulation in emergency and critical care departments. Emerg Med J. 2016 Jul 1;33(7):514-6. Disponible en: https://pubmed.ncbi.nlm.nih.gov/26969169/
20. Jee M, Murphy E, Umana E, O’connor P, Khamoudes D, Mcnicholl B, et al. Exploring barriers and enablers to simulation-based training in emergency departments: an international qualitative study (BEST-ED Study). BMJ Open. 2023 Sep 5;13(9). Disponible en: https://pubmed.ncbi.nlm.nih.gov/37669835/
21. Verhagen MJ, de Vos MS, Smaggus A, Hamming JF. Measuring What Matters at Morbidity and Mortality Conferences: A Scoping Review of Effectiveness Measures. J Patient Saf. 2022 Jun 1;18(4):E760-8. Disponible en: https://pubmed.ncbi.nlm.nih.gov/35617601/
22. Murakami T, Yamamoto A, Hagiya H, Obika M, Mandai Y, Miyoshi T, et al. The effectiveness of simulation-based education combined with peer-assisted learning on clinical performance of first-year medical residents: a case-control study. BMC Med Educ. 2023 Dec 1;23(1):1-10. Disponible en: https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-023-04798-w
23. Salas E, Reyes DL, McDaniel SH. The science of teamwork: Progress, reflections, and the road ahead. Am Psychol. 2018 May 1;73(4):93-600.
24. Carne B, Kennedy M, Gray T. Review article: Crisis resource management in emergency medicine. Emerg Med Australas. 2012 Feb 1;24(1):7-13. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1742-6723.2011.01495.x
25. Weile J, Nebsbjerg MA, Ovesen SH, Paltved C, Ingeman ML. Simulation-based team training in time-critical clinical presentations in emergency medicine and critical care: a review of the literature. Adv Simul. 2021 Dec 1;6(1):1-12. Disponible en: https://advancesinsimulation.biomedcentral.com/articles/10.1186/s41077-021-00154-4
26. Jeong J, Lee SW, Kim WY, Han KS, Kim SJ, Kang H. Development and validation of a scoring system for mortality prediction and application of standardized W statistics to assess the performance of emergency departments. BMC Emerg Med. 2021 Dec 1;21(1):1-9. Disponible en: https://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-021-00466-8
27. Patterson MD, Geis GL, LeMaster T, Wears RL. Impact of multidisciplinary simulation-based training on patient safety in a paediatric emergency department. BMJ Qual Saf. 2013 May 1;22(5):383. Disponible en: http://qualitysafety.bmj.com/content/22/5/383.abstract
28. Petrosoniak A, Ryzynski A, Lebovic G, Woolfrey K. Cricothyroidotomy in situ simulation curriculum (CRIC Study). Simul Healthc. 2017 Apr 1;12(2):76-82. Disponible en: https://journals.lww.com/simulationinhealthcare/fulltext/2017/04000/cricothyroidotomy_in_situ_simulation_curriculum.3.aspx
29. Naemi A, Schmidt T, Mansourvar M, Naghavi-Behzad M, Ebrahimi A, Wiil UK. Machine learning techniques for mortality prediction in emergency departments: a systematic review. BMJ Open. 2021 Nov 2;11(11). Disponible en: https://pubmed.ncbi.nlm.nih.gov/34728454/
30. Rosen MA, Salas E, Silvestri S, Wu TS, Lazzara EH. A measurement tool for simulation-based training in emergency medicine: the simulation module for assessment of resident targeted event responses (SMARTER) approach. Simul Healthc. 2008 Sep;3(3):170-9. Disponible en: https://pubmed.ncbi.nlm.nih.gov/19088661/
31. Geis GL, Pio B, Pendergrass TL, Moyer MR, Patterson MD. Simulation to assess the safety of new healthcare teams and new facilities. Simul Healthc. 2011 Jun;6(3):125-33. Disponible en: https://journals.lww.com/simulationinhealthcare/fulltext/2011/06000/simulation_to_assess_the_safety_of_new_healthcare.1.aspx
32. Davis D, Warrington SJ. Simulation Training and Skill Assessment in Emergency Medicine. StatPearls. 2023 May 1. Disponible en: https://www.ncbi.nlm.nih.gov/sites/books/NBK557695/
33. Vozenilek J, Wang E, Kharasch M, Anderson B, Kalaria A. Simulation-based morbidity and mortality conference: new technologies augmenting traditional case-based presentations. Acad Emerg Med. 2006 Jan;13(1):48-53. Disponible en: https://pubmed.ncbi.nlm.nih.gov/16365338/
34. Ju M, Bochatay N, Robertson K, Frank J, O’Brien B, van Schaik S. From ideal to real: a qualitative study of the implementation of in situ interprofessional simulation-based education. BMC Med Educ. 2022 Dec 1;22(1):1-11. Disponible en: https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-022-03370-2
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Publicado
jun 16, 2025
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Villanueva-Valverde, J. F., Chavarría Campos, J., Asenjo Alvarado, S., Vargas Ramírez, J. J., & Juan Pablo Vargas Guido, J. P. V. G. (2025). Simulación clínica in situ en servicios de emergencia: implicancias para la seguridad del paciente. Revista Hispanoamericana De Ciencias De La Salud, 11(1), 35–43. https://doi.org/10.56239/rhcs.2025.111.912
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Articulo Especial
Derechos de autor 2025 José Francisco Villanueva-Valverde, MD Javier Chavarría Campos, Lic. Silvia Asenjo Alvarado, Lic. José Jesús Vargas Ramírez, Lic. Juan Pablo Vargas Guido
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
La RHCS usa la licencia Creative Commons 4.0 Internacional (CC BY 4.0). Para obtener más información, visite https://creativecommons.org/licenses/by/4.0/
Biografía del autor/a
MD Javier Chavarría Campos, Red de Servicios de Salud. Instituto Nacional de Seguros. Costa Rica.
Especialista en Medicina de Emergencias
Lic. Juan Pablo Vargas Guido, Red de Servicios de Salud. Instituto Nacional de Seguros. Costa Rica.
Licenciado en Enfermería