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What are the Background, PICOT/variable, Problem Statement, and Purpose Statement: Abstract Background Nurses’ response to patient deterioration in acute hospital wards is a priority issue. Simulation education programs improve nurses’ knowledge and confidence, but the translation into better care is largely unknown for both web based (WB) and face to face (F2F) simulation programs. Aim To measure the impact of simulation education on nurses’ response to patient deterioration in acute medical ward settings, and to compare the impact of WB and F2F versions. Design An interrupted time series, non-randomised trial across four medical wards in Victoria, Australia. Wards were allocated to either web-based or face-to-face versions of the same simulation program, FIRST2ACT. Interrupted time series measurement for six fortnights both before and after the intervention were used to measure and compare responses to deterioration. Responses to patient deterioration were extracted from medical records and grouped into outcomes for escalation (e.g. initiation of clinical review), assessment and observation (e.g. increased recording of vital signs, conscious state and pain scores) and clinical interventions (e.g. oxygen administration). Results 126 nurses (89%) participated across the four wards. 946 patient records (506 in the F2F; 440 in the WB group) were included in analyses. There were significant and sustained improvements between pre and post samples in outcomes for escalation (13.0% to 28.8%; p = 0.000) and assessment and observation (conscious state recorded increased from 91.1% to 100%; p = 0.000, and pain score recorded increased from 97.8% to 99.8%; p = 0.000). There were no differences between the web-based and face-to-face groups except in appropriate oxygen application which increased by 7.7% in the F2F group and decreased by 11.8% in the WB group (p = 0.046). Conclusions There was a significant improvement in nurses’ response to patient deterioration following both versions of simulation, indicating that both have a role to play in supporting nurses’ response to patient deterioration. Access through your organization Check access to the full text by signing in through your organization. Access through St. Jude Children’s Resea… Section snippets Background Educational preparation of the nursing workforce to ensure appropriate knowledge, skills, behaviours and responses to patient deterioration is a world-wide priority (ACSQH, 2017; Walton et al., 2006). Simulation-based education is a widely used approach, with well-designed programs creating genuine learning opportunities closely aligned to everyday clinical practice (Cantrell et al., 2017; Satin, 2018). Contemporary approaches use a range of simulation modalities including face-to-face Aim To measure the impact of simulation on nurses’ response to patient deterioration in an acute medical ward setting and compare the impact of web-based and face-to-face modalities. Objectives 1. To measure the impact of the FIRST2ACT simulation education program on nurses’ response to patient deterioration; 2. To compare the impact of the face-to-face simulation program with the web-based program on nurses’ response to patient deterioration. Research design We conducted an interrupted time series, non-randomised trial across four Sample Participants completed the education program, following introductory onsite sessions, between February and June 2016. One-hundred-and-twenty-six nurses participated from 141 staff (89% participation rate). Participation for face-to-face simulation was 68/75 (91%) and 58/66 (88%) for web-based simulation. A total of 1951 medical records were accessed in the three months before and three months after the simulation education programs. The dataset was filtered to remove admission records where a Discussion This study demonstrates that the simulation education program contributed to increases in escalation, observations and interventions (except for oxygen administration in the web-based group) for deteriorating patients and that this occurred for both WB and F2F versions. This substantially adds to the small, but growing, body of evidence that simulation can translate into improved clinical practice and represents a shift away from the restrictions of reporting only on satisfaction, knowledge or Conclusions This innovative study demonstrated a link between simulation education and improved responsiveness to patient deterioration by nurses in acute medical wards, regardless of whether the program was web based or face to face. There were significant increases in escalation of care and documentation of conscious state and pain scores. These are important findings for hospital policy-makers, educators and clinicians in acute wards where patient deterioration is common and a priority issue in patient

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