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Reducing serious incidents through simulation training

In partnership with Health Education England, East London NHS Foundation Trust focused on improving patient safety by enabling members of multi-professional teams to learn from simulated serious incidents in a safe and supervised environment


The project brought together different professions to learn from, and be prepared for, serious incidents through interactive training sessions. These sessions provided a safe space for junior doctors and nurses to explore and reflect in a more direct and meaningful way. The project used simulation training as an education intervention to:

  • Support the prevention of, and/or the management of, serious incidents
  • Promote learning in multi-professional teams
  • Highlight the importance of team work and communication in the clinical arena.

How they did it

Training was developed in-house using anonymised information from internal serious incident reviews, which informed the learning points included in the clinical simulation scenarios. Two clinical scenarios based around inpatient care issues were role-played by course delegates, and each scenario embedded various care and service delivery problems. This resulted in learning points for discussion in the subsequent debrief sessions.

Who was involved

The pilot project team allocated a nursing and a medical lead facilitator for the simulation training, and identified a pool of nursing and medical clinicians to become simulation trainers to help deliver the programme. They commissioned a bespoke trainer course with additional follow-up sessions from expert simulation trainers. They also established the programme of simulation training to be delivered long-term, including the number and frequency of sessions per month. Training will continue to be managed and supported by the medical education department, and reviewed and monitored by the Trust’s newly established training and education department.

What they achieved

  • An improved understanding about the learning from serious incidents between doctors and nurses, leading to a more open multi-professional culture
  • More than 80% of trainees reported an increase in confidence and 98% of trainees felt that the training initiative would change their practice
  • An improvement in multi-professional team working and improved confidence in communicating with senior health professionals in 88% of trainees. An improvement in staff knowledge on key areas around serious incidents
  • A review of pre and post incident reporting data for those delegates who attended the training showed an increase in incident reporting
  • The delivery of the simulation raised the profile of this training method to clinical staff and senior management. There is now a commitment from the Trust to continue providing the training beyond the pilot.

What they’ve said

“I have learnt to prioritise what I communicate to my colleagues in terms of a patient’s risk and overall presentation, in order to come up with a better management plan”

Medical trainee

“Great learning in a role play environment – allows for emotive learning which will stay with me for longer than a handbook” –

Nursing trainee

“These were extremely realistic scenarios which bring out the key clinical and softer interpersonal skills. Supporting and debriefing trainee doctors and nurses through these scenarios give the opportunity to accelerate learning in a way which just isn’t available on the wards or offices” 

Medical facilitator

“My communication and facilitation skills have greatly improved. I gained a good insight into how doctors and nurses see each other” –

Nursing facilitator


Please look at the toolkit materials in the related document section below. The top tips and business cases have been developed by the BTBC team to support organisations to implement these changes and the case studies and project resources have been developed and approved by the project teams.

The top tips include lessons learnt that have been identified throughout the project. The business case will guide you through the management principles and communications and engagement activities. The case studies provide a detailed overview of the project. Feel free to adapt these resources to suit your projects.
Your organisation may have its own materials and templates that you can use or you may find the NHS Improving Quality (NHS IQ) learning handbook useful too.

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