Managing medical emergencies in mental health settings using an interprofessional in-situ simulation training programme: A mixed methods evaluation study

Abstract

Background: In the UK, people with severe mental illness die up to 20years earlier than the general population, prompting increased focus on physical health in mental illness. However, training for mental health inpatient staff to meet patients' physical health needs has not received the same attention, with physical health training often being reactive and lacking evidence of effectiveness.

Objectives: To evaluate an interprofessional, in situ, simulation training intervention for managing medical deterioration in mental health settings. Investigating the impact of training on: 1. Participants' knowledge, confidence, and attitudes towards managing medical deterioration; and 2. Incident reporting, as an objective index of incident management. Participants' perceptions of the impact on their practice were qualitatively explored.

Design: This evaluation employed a mixed-methods pre-post intervention design.

Participants & settings: Fifty-three healthcare professionals participated including: mental health nurses, psychiatrists, healthcare assistants, and activity co-ordinators from two busy psychiatric triage wards in South London, UK.

Methods: The intervention comprised eight half-day sessions delivered weekly across two wards. Structured surveys assessed participants' knowledge, confidence, and attitudes towards medical deterioration pre and post training. Participants' experience of training was qualitatively captured through post-course surveys and focus groups three months post training. Incident reporting rates for seven-month periods pre and post training were compared.

Results: Following training, participants showed significant improvement in knowledge (p<0.001), confidence (p<0.001), and attitudes towards (p<0.02) managing medical deterioration. Incident reporting increased by 33% following training. Participants' reported improved confidence in managing medical deterioration, better understanding of effective communication, improved self-reflection and team working, and an increased sense of responsibility for patients' physical health.

Conclusions: Interprofessional, in situ simulation training for medical deterioration yielded promising outcomes for individuals and teams. Simulation is an under-used training modality in mental health, offering a holistic training approach with the potential to provide educational and clinical benefits while supporting workforce resilience.

Keywords: Healthcare education; Interprofessional education; Medical emergency; Mental health; Multi-disciplinary teams; Nursing training; Psychiatry; Simulation.