Louise Allen

101 – The impact of face-to-face and web-based simulation on patient deterioration and patient safety

Louise Allen

There are significant patient safety concerns regarding nurses’ ability to manage patients that are physiologically deteriorating.  The degree to which face-to-face (F2F) and/or web based (WB) simulation programmes impact care is unknown.

A mixed methods interventional cohort trial was used to compare the effectiveness of two forms of simulation education F2F versus WB, on nurses’ ability to manage patient deterioration.

Australian nurses in Victoria were trained in primary response, to emergencies, in a public medical ward in two regional hospitals and in two private hospitals using either F2F or WB versions of the patient deterioration programme First2Act. Participant performance was rated, focus groups and cost benefit analyses completed, and patient vital sign charts reviewed (3 month pre and post intervention).

A total of 129 nurses attended training from the four hospitals.  We also reviewed 1,951 patient notes.  Knowledge, confidence and competence increased significantly (p=<0.001) in both F2F and WB programmes. 60% of patients met the ‘clinical review’ criteria, of which 12% were correctly reviewed pre-intervention and 29% post-intervention – with no difference in effect between F2F and WB interventions.  The WB intervention had significant cost benefits.  Focus groups identified the benefits and limitations of the programmes and concerns around the management of deterioration and the prescriptive nature of vital sign charts.


Both F2F and WB programmes had significant educational and clinical impact with cost benefits for WB training.  To reduce the time it takes to reach competency and to reduce F2F time, the use of BOTH programmes is recommended i.e. ‘Blended learning’.


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