In-Situ Simulation for Enhancing Safety in Outpatient Hysteroscopy: Development and Evaluation of a Crisis Resource Management-Based Training Package.

INTRODUCTION

Hysteroscopy is a common gynecologic procedure increasingly performed in outpatient settings, yet in Canada cases still occur in operating rooms. As care transitions to ambulatory suites, processes for managing complications remain poorly defined. This educational initiative aimed to design in-situ simulation scenarios to enhance patient safety during outpatient hysteroscopy by strengthening team preparedness and identifying system gaps.

METHODS

A needs assessment was conducted via literature review and interviews with local staff. Findings informed the creation of 4 simulation scenarios targeting the most common and catastrophic adverse events in the outpatient setting: intravenous sedation overdose, hemorrhage, local anesthetic toxicity, and vasovagal reaction. Physicians and nurses working in the outpatient suite were invited to participate. Surveys assessing self-efficacy components on a 5-point Likert scale were administered pre- and postsimulation.

RESULTS

Existing literature revealed minimal simulation-based training for outpatient hysteroscopy. Twelve participants (8 physicians, 4 nurses), with experience ranging from 6 months to 23 years, engaged in 4 simulation sessions. Across all measured domains, participants reported improved confidence in managing complications.

DISCUSSION: Simulation effectively prepares teams for rare, high-acuity events but remains underutilized in ambulatory gynecology. These scenarios can be deployed in simulation centers to enhance crisis resource management or in-situ to uncover latent safety threats and test system readiness. They offer a structured approach to support the safe establishment of outpatient hysteroscopy services and can serve as a continuing quality assurance tool. Implementing standardized, team-based simulation may help close safety gaps as outpatient hysteroscopy becomes the preferred standard of care.