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RESEARCH PRODUCT

Medical simulation for ICU staff: does it influence safety of care?

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Dear Editor, We read with great interest the article by Garrouste-Orgeas et al. entitled ‘‘Understanding medical errors and adverse events in ICU patients’’ [1]. In particular, two sentences caught our attention: ‘‘medical errors are the consequence of multiple actions of a whole chain of organizational and humans interaction...’’ and ‘‘leadership, trust, respect, open communication, non-punitive actions and coordination of behavior are essential for a multidisciplinary ICU team to provide safe care’’. In a teamworking setting like the ICU, shared knowledge and non-technical skills are pivotal to deliver a high quality of care and to reduce medical errors. Medical simulation has been demonstrated to improve knowledge, selfconfidence, non-technical skills and team performance in various settings like emergency care, trauma and anaesthesia [2, 3]. Accepting that medical error is frequent, complex and not related to a single individual behaviour, the widespread use of simulation-based learning during the last 20 years may be seen as an attempt to prevent and reduce it [4]. Targeted practice of medical simulation, based on learning-by-doing theory [5], may improve many of the factors influencing safety of care, namely ICU leadership, team work, work organization, caregiver wellbeing and awareness of error as described by the authors [1]. To know what to do, to learn and implement methods to interact with other members of the team and to deal with critical events in a safe setting are pivotal goals to achieve safer care in the ICU. However, in light of an effort to reach the goal of prevention of medical errors and adverse events in ICU, we believe that we should start to consider simulation as a core part of ICU staff training. Compliance with ethical standards