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New Resource Promotes Learning From Patient Safety Events Among Healthcare Staff

Educational videos of facilitated debriefs following patient safety events, co-designed and developed by RCSI with the HSE National Quality and Patient Safety Directorate, have been published in BMJ Open Quality.

The open access article, led by Dr Siobhán McCarthy, Lecturer at the Graduate School of Healthcare Management, RCSI University of Medicine and Health Sciences, provides video resources designed to educate healthcare staff about a methodology known as After Action Review (AAR).

After Action Review is a non-hierarchical facilitated debrief of an event where groups discuss: what did we expect to happen; what actually happened; why was there a difference; and what have we learnt?

The publication includes access to the online videos of simulated AARs and an associated case scenario of a patient safety event. These have the potential to be used widely to support social and near-to-real-time learning from patient safety and everyday events.

Since 2018, the RCSI Graduate School of Healthcare Management has trained up to 500 healthcare staff as AAR facilitators across the Irish health services, using an in-person simulation-based programme co-designed and funded by the HSE National Quality and Patient Safety Directorate (NQPSD). Subsequently, RCSI and the HSE formed a research collaboration to assess the implementation and effect of AAR at a hospital site.

Arising from the collaboration, RCSI and the HSE have released a series of videos of simulated AARs to help spread and sustain AAR awareness and facilitation skills. The videos demonstrate the purposes of an AAR, the AAR process, and the skills required to facilitate an AAR effectively.

Dr Siobhán McCarthy said, “by using digital technology and a university-health service partnership approach, we hope that this open-access educational resource will enhance awareness of AAR as a learning tool and of the skills required to facilitate AARs. Effective AAR facilitation skills are important to support staff participating in AARs and to help identify learning and improvement actions.”

Lorraine Schwanberg, Assistant National Director for Incident Management at the HSE NQPSD, emphasised that, “AAR forms part of a suite of incident response options as part of the HSE Incident Management Framework and we look forward to using this resource as part of the development of AAR across the health services.”

The videos were developed with funding from the Health Research Board Applied Partnership Award (APA-2019-024) and includes co-funding from the Health Services Executive.

Source: RCSI

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