Simulation for elite team performance

Podcast – Simulation for Elite Team Performance with Andrew Petrosoniak at Tactical Trauma 2024

This post accompanies the podcast “Simulation for Elite Team Performance,” which was recorded live at the Tactical Trauma 2024 conference in Sundsvall, Sweden. We are grateful to the organizing team for hosting us and allowing us to use the audio.

In this episode, Andrew Petrosoniak leads us through how simulation can be used beyond education for system design and improvement.


Listening Time – 20.12

Author – Andrew Petrosoniak

In emergency medicine and trauma care, we’re accustomed to acting fast and thinking on our feet. But I also spend a lot of time working on simulation, a powerful tool for training and investigating issues within clinical environments. Today, I want to share how simulation can transform our systems, prevent catastrophic failures, and help us deliver better care.

Let’s rewind to 2018. I was standing in the trauma bay at St. Mike’s, a Level 1 trauma centre in Toronto. We had just received a critically injured patient involved in an ATV accident—a four-wheeler rollover, to be precise. The patient was bleeding profusely, with a pelvic binder in place, and we knew we needed to act fast.

We prepared for intubation, established IV access, and ordered blood. But there was one major problem—no blood arrived. Minutes ticked by, 5 minutes, then 10 minutes, then 15. By the time the blood finally reached us, 17 minutes had passed. Watching someone actively bleed for 17 minutes feels like an eternity. While the patient ultimately did fine, the delay in blood delivery was unacceptable.

After that experience, I started asking colleagues if they had encountered similar delays, and many had. Like many others, our hospital had a well-established Massive Haemorrhage Protocol (MHP), but something wasn’t working. When I need to investigate a problem, I turn to simulation—not just for training purposes but to dig deeper into system failures.

Identifying System Failures Through Simulation

A few weeks after the incident, we ran simulations to understand why we were facing delays in getting blood to the trauma bay. What we observed during these sessions was eye-opening. Our nurses were task-overloaded—they were responsible for charting, establishing IV access, and, crucially, making phone calls to both the blood bank and the hospital’s locating service to request a porter. This two-step process was cumbersome, and sometimes the call to the blood bank was simply forgotten amidst the chaos of a trauma.

In response, we developed a new process: the call would be automatically forwarded to the blood bank when the nurse called the locating service. Simple, right? With just one call to make, the system would take care of the rest. However, before rolling out this new protocol, we wisely decided to test it using simulation.

During the test, something went wrong—the call kept dropping. It turns out that emergency phone lines can’t be forwarded, an issue no one had anticipated. Thankfully, this problem was discovered in a simulated environment where no patients were harmed. IT fixed the issue, but had we not tested the new process through simulation, this failure might have persisted for days or weeks, with staff blaming the locating service rather than the system itself.

This example highlights the concept of intelligent failure. By creating a venue where failure is safe, such as in simulation, we can identify and fix problems before they affect real patients.

Embracing Intelligent Failure

Most of us associate failure with negativity, especially in patient care. When something goes wrong, we internalize it and feel like we’ve personally failed. But failure can be a powerful tool if approached correctly. Amy Edmondson, the same expert who introduced the concept of psychological safety, popularised this idea of intelligent failure.

There are four key elements to intelligent failure:

  1. Novel Approach: Try something new. In our case, the novel approach automatically forwarded the call to the blood bank.
  2. Hypothesis: We hypothesized that this would reduce the likelihood of missed calls and speed up blood delivery.
  3. Benefit: The expected benefit was a more streamlined process, leading to faster delivery of blood products to the trauma bay.
  4. Minimal Risk: In simulation, the risks are contained, and no patients are harmed.

We can iterate, improve, and ultimately succeed by embracing intelligent failure. In fact, we saw a 21% reduction in time to blood delivery after implementing this simulation-informed process. Over the years, we’ve further refined the system, achieving a nearly 50% improvement. The simulation allowed us to safely test ideas, fail, and try again—without any real-world harm.

Data Integration in Simulation

We all know that sports teams use data to enhance performance. But in healthcare, we’re still catching up. Sure, I know how long a patient waits in the emergency department for an ankle sprain, but what about the quality of care during a cardiac arrest? How good was the CPR? How well did our team perform?

To answer these questions, we turned to data. We could objectively measure performance by integrating data from defibrillators and other devices into our simulations. For instance, during one simulation, we used data from a Zoll defibrillator to assess chest compression fraction (CCF)—the percentage of time during a cardiac arrest that chest compressions are being performed. The team achieved a CCF of 87%, well above the 80% target.

This objective feedback was invaluable. The team could see, in real-time, how well they had performed, and it boosted morale. No more subjective assessments—just clear, hard data.

We didn’t stop there. We also used data to redesign clinical spaces. By running simulations and tracking where staff spent most of their time during trauma resuscitations, we could optimize the layout of our trauma bays. Equipment was moved to the areas where it was most needed, reducing wasted time and effort. Simulation wasn’t just improving individual performance—it was improving our entire system.

Scaling Impact with Simulation

Not all of us have the luxury of working with the same team every day, like a sports team does. In trauma care, our teams are often ad-hoc, with different people working different shifts. Training becomes a challenge when you can’t predict who will be there on any given day. But that doesn’t mean we can’t scale the impact of simulation across a larger, variable workforce.

At St. Mike’s, we’ve introduced a CPR coach role, and we used simulation to train the team in this new role. The best part? We zoomed the simulations out to those who couldn’t be physically present and video-recorded them for future learning. This allows us to scale our educational efforts and ensure that even shift workers can access the same training.

We also use simulation when designing or renovating clinical spaces. Rather than conducting lengthy orientation sessions to teach staff where equipment is located, we design the space intelligently from the start. Equipment is placed where it’s most likely to be needed, minimizing cognitive load and freeing staff to focus on critical decision-making.

The Future of Simulation in Healthcare

The future of healthcare lies in using simulation not just for training individuals and teams but for improving entire systems. By embracing intelligent failure, integrating data, and scaling the impact of simulation, we can create safer, more efficient environments for both patients and healthcare providers.

At St. Mike’s, we’ve seen first-hand how simulation can revolutionize trauma care, and we’re excited to continue pushing the boundaries of what’s possible. Simulation allows us to test new ideas, identify problems before they reach patients, and continuously improve our processes.

So, the next time you think of failure, try to view it through the lens of opportunity. Simulation provides a safe space for failure, and through failure, we learn, adapt, and ultimately succeed.

If you’re interested in learning more or discussing how simulation can be implemented in your practice, feel free to contact me. Together, we can harness the power of simulation to improve healthcare for everyone.


Podcast Transcription


The Guest – Andrew Petrosoniak

Dr. Andrew Petrosoniak is an emergency physician and trauma team leader at St. Michael’s Hospital and an Assistant Professor in the Department of Medicine at the University of Toronto. He has completed a Master of Science in medical education where he focused on the use of in situ simulation (practice in the actual workplace) in procedural skill acquisition.

Andrew’s field of research includes in situ simulation and simulation-based technical skill acquisition. His work focuses on usability testing and the identification of personnel- and systems-based safety threats within acute care medicine. He is the principal investigator of the TRUST study (Trauma Resuscitation Using in Situ simulation for Team Training) that includes a partnership with human factors experts to evaluate systems and processes during high-stakes trauma simulations.

He is an invited speaker both nationally and internationally on the topics of trauma, simulation and procedural skill acquisition.

Andrew Petrosoniak

Where to Listen

You can listen to our podcast in numerous ways, ensuring you never miss an episode no matter where you are or what device you’re using. For the traditionalists, Apple Podcasts and Google Podcasts offer easy access with seamless integration across all your Apple or Android devices. Spotify and Amazon Music are perfect for those who like to mix their tunes with their talks, providing a rich listening experience. If you prefer a more curated approach, platforms like Podchaser and TuneIn specialize in personalising content to your tastes. For those on the go, Overcast and Pocket Casts offer mobile-friendly features that enhance audio quality and manage playlists effortlessly. Lastly, don’t overlook YouTube for those who appreciate a visual element with their audio content. Choose any of these platforms and enjoy our podcast in a way that suits you best!



Tactical Trauma

Huge thanks to Fredrik Granholm and all at Tactical Trauma 24 for their very warm welcome and for letting us record this series of podcasts. This is a fantastic conference, and we would highly recommend you check it out when they advertise their next event.


Cite this article as: Iain Beardsell, "Podcast – Simulation for Elite Team Performance with Andrew Petrosoniak at Tactical Trauma 2024," in St.Emlyn's, October 23, 2024, https://www.stemlynsblog.org/podcast-simulation-for-elite-team-performance/.

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