Mannequin-based Simulation for Clinical Deterioration

An educational programme using high-fidelity simulation (RAPIDS-Sim) was developed to enhance clinical performance in assessing, managing, and reporting of clinical deterioration.

The programme consists of a six-hour simulation session using multiple clinical scenarios associated with acute medical conditions. Acute deteriorating conditions such as airway obstruction, breathlessness, hypotension, tachycardia, oliguria, altered consciousness and abnormal temperature are embedded in these scenarios. Each scenario leads the learners to assess, manage, and report about a patient’s deterioration. The simulation scenario is followed immediately by a debriefing session when learners receive feedback from the facilitators using the RAPIDS-Tool.

A randomised controlled trial has provided strong evidence on the effectiveness of the RAPIDS-Sim in enhancing the learners’ clinical performance in assessing, managing, and reporting of clinical deterioration.¹⁰ A qualitative study has described the translational outcome of the programme on learners’ performance when encountered with deteriorating patient in the actual clinical setting. This study has also identified further educational strategies to enhance the realism of simulation through the use of simulated patients and self-directed learning with multimedia resources.¹¹

Further innovations focusing on stress/anxiety reduction strategies were incorporated into the RAPIDS-Sim to address the emotional learning of the learners.^{12, 13}

Please read the following articles for a detailed description and evaluation of the RAPIDS-Sim.

1. Liaw SY, Rethans JJ, Scherpbier A, Piyanee KY. Rescuing A Patient In Deteriorating Situations (RAPIDS): a simulation-based educational program on recognizing, responding and reporting of physiological signs of deterioration. Resuscitation. 2011;82(9):1224-30. [Medline: 21664026]




2. Liaw SY, Chan SW, Scherpbier A, Rethans JJ, Pua GG. Recognizing, responding to and reporting patient deterioration: transferring simulation learning to patient care settings. Resuscitation. 2012;83(3):395-8. [Medline: 21946262]




3. Ignacio J, Dolmans D, Scherpbier A, Rethans, JJ, Chan S, Liaw SY. Comparison of standardized patients with high-fidelity simulators for managing stress and improving performance in clinical deterioration: a mixed methods study. Nurse Education Today. 2015;35(12):1161-8. [Medline: 26047602]




4. Ignacio J, Dolmans D, Scherpbier A, Rethans, JJ, Lopez V, Liaw SY. Development, implementation, and evaluation of a mental rehearsal strategy to improve clinical performance and reduce stress: A mixed methods study. Nurse Education Today. 2016; 37:27-32. [ Medline: 26602239]