Enhancing Interprofessional Team Performance to Prevent Medication Errors in Emergency Care: Quasi-Experimental Study Using Multimodal Virtual Simulation-Based Interprofessional Education

TL;DR

A virtual simulation training program improved teamwork and communication among emergency care professionals, leading to better safety practices and increased error reporting.

Contribution

ER-VIPE is a novel multimodal interprofessional education intervention that integrates virtual simulation and TeamSTEPPS to enhance emergency care teamwork and reduce medication errors.

Findings

ER-VIPE improved interprofessional team performance scores significantly in both simulation and real-world emergency department settings.

Near-miss prescription error reporting increased significantly after the intervention, indicating improved safety culture.

The greatest improvements in team performance were observed among physicians, followed by nurses and pharmacists.

Abstract

Effective interprofessional collaboration (IPC) is essential for patient safety; yet, poor teamwork and communication remain key challenges in high-pressure settings like the emergency department (ED), contributing to medication errors. Although Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS)–based interprofessional education addresses these issues, adaptation in clinical settings remains difficult. To bridge this gap, we developed Emergency Room Virtual Simulation-Based Interprofessional Education (ER-VIPE), a multimodal, TeamSTEPPS-integrated intervention designed to enhance IPC and reduce medication errors.

The aim of the study is to evaluate the effectiveness of ER-VIPE in enhancing IPC performance among emergency physicians, nurses, and pharmacists and in reducing medication errors. The primary objective is to assess changes in IPC performance in both real-world ED settings and in computer-based simulations. The secondary objective is to examine the intervention’s impact on medication error rates in the ED.

This quasi-experimental study involved 15 interprofessional teams (each comprising 1 physician, 1 pharmacist, and 2 nurses), undergoing the ER-VIPE training. This multimodal intervention included 2 medical films, a massive open online course on TeamSTEPPS and IPC, and a computer-based simulation session on acute chest pain and cardiac arrest scenarios via the simulation-based interprofessional education (SIMBIE) platform. Co-debriefings were provided as a complement to the SIMBIE session, guiding participants through positive feedback and areas of improvement. TeamSTEPPS performance was measured using the Modified TeamSTEPPS and Team Performance Observation Tool (mTPOT) in both simulation and real-world ED settings. Generalized estimating equations with a Gaussian family, identity link, and exchangeable correlation structure were used to evaluate IPC score changes. Chi-square and Fisher exact tests were applied to compare near-miss and actual medication errors before and after the intervention. A 2-tailed P value <.05 was considered statistically significant.

The study was conducted from November 2023 to January 2024 at a university hospital with 60 participants. Following the co-debriefing session in the simulation, overall mTPOT scores increased by 2.00 points (P<.001), with the greatest improvement among physicians (+2.70), followed by nurses (+1.75) and pharmacists (+1.56). In the ED, most mTPOT domains improved significantly across all professions 2 months after the intervention (P<.001). Although no significant reduction in harmful medication errors was observed, reporting of near-miss prescription errors increased significantly (P=.01).

ER-VIPE enhanced IPC among ED physicians, nurses, and pharmacists, with sustained effects observed up to 2 months in real-world settings. The combination of medical films and massive open online courses provided accessible foundational knowledge, while computer-based virtual SIMBIE with co-debriefing reinforced practical communication and teamwork. Increased near-miss reporting suggests improved situational awareness and a more transparent safety culture. This multimodal training model shows promise for advancing collaboration and patient safety in emergency care.

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