Behavioural emergencies involving aggression in acute care hospitals are increasing globally. Acute care staff are often not trained or confident in their prevention or management. Of available training options simulation-based education is superior for clinical medical education and is gaining acceptance for teaching clinical aggression management skills. The aim of this study was to conduct a systematic review of the effectiveness of simulation-based education for teaching aggression management skills for health professionals working in acute healthcare settings. The study protocol was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) statement, registered (27/02/2020) and published. We included randomised controlled trials, non-randomised controlled trials, quasi-experimental studies, and observational studies involving healthcare professionals in acute hospital settings or trainee health professionals who received simulation-based training on managing patient aggression. Comprehensive searches were conducted in PubMed, Ovid MEDLINE, PsycINFO, CINAHL and The Cochrane Library. Two reviewers independently screened all records, extracted data and assessed risk of bias. The primary outcomes included patient outcomes, quality of care, and adverse effects. Secondary outcomes included workplace resource use, healthcare provider related outcomes, knowledge (de-escalation techniques), performance, attitudes, and satisfaction. A narrative synthesis of included studies was performed because substantial variation of interventions and outcome measures precluded meta-analyses. Twenty-five studies were included with 2790 participants, 2585 (93 %) acute care hospital staff and 205 (7 %) undergraduate university students. Twenty-two studies combined simulation-based education with at least one other training modality. Three studies were randomised controlled trials, one was a pilot and feasibility cluster randomised controlled trial, one was a three-group post-test design and twenty were pre-/post-test design. Twenty-four studies were deemed to be high/critical or serious risk of bias. Four studies collected primary outcome data, all using different methods and with inconsistent findings. Twenty-one studies assessed performance in the test situation, seven studies provided objective ratings of performance and eighteen provided self-report data. Twenty-three studies reported objective or subjective improvements in secondary outcomes. Acute healthcare staff who completed simulation-based education on managing clinical aggression showed statistically significant improvements in knowledge and self-reported confidence. However, there is a lack of evidence about the magnitude of these improvements and impact on patient outcomes. PROSPERO Registration Number CRD42020151002. Simulation-based education improved acute healthcare clinician knowledge and confidence in managing aggression.

中文翻译：

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基于模拟的教育，用于在紧急医疗环境中向医疗保健提供者传授攻击管理技能：系统评价


全球范围内，急症护理医院中涉及攻击行为的紧急事件正在增加。急症护理人员往往没有接受过培训，对其预防或管理也缺乏信心。在可用的培训选项中，基于模拟的教育更适合临床医学教育，并且在教授临床攻击管理技能方面正在获得认可。本研究的目的是对基于模拟的教育对在紧急医疗环境中工作的卫生专业人员教授攻击性管理技能的有效性进行系统评价。该研究方案是根据系统评价和荟萃分析方案的首选报告项目 (PRISMA-P) 声明编写的，已注册（2020 年 2 月 27 日）并发布。我们纳入了随机对照试验、非随机对照试验、准实验研究和观察性研究，涉及急性医院环境中的医疗保健专业人员或接受基于模拟的患者攻击行为管理培训的实习医疗专业人员。在 PubMed、Ovid MEDLINE、PsycINFO、CINAHL 和 Cochrane 图书馆进行了全面检索。两名评审员独立筛选所有记录、提取数据并评估偏倚风险。主要结局包括患者结局、护理质量和不良反应。次要结果包括工作场所资源使用、医疗保健提供者相关结果、知识（降级技术）、绩效、态度和满意度。由于干预措施和结果测量的巨大差异排除了荟萃分析，因此对纳入的研究进行了叙述性综合。 纳入 25 项研究，涉及 2790 名参与者、2585 名 (93%) 急症护理医院工作人员和 205 名 (7%) 本科生。二十二项研究将模拟教育与至少一种其他培训方式结合起来。三项研究是随机对照试验，一项是试点和可行性整群随机对照试验，一项是三组后测试设计，二十项是前/后测试设计。二十四项研究被认为具有高/关键或严重偏倚风险。四项研究收集了主要结果数据，所有研究都使用不同的方法，但结果不一致。二十一项研究评估了测试情况下的表现，七项研究提供了客观的表现评级，十八项研究提供了自我报告数据。二十三项研究报告了次要结果的客观或主观改善。完成基于模拟的临床攻击性管理教育的急性医护人员在知识和自我报告的信心方面显示出统计上的显着改善。然而，缺乏证据表明这些改善的程度以及对患者结果的影响。 PROSPERO 注册号 CRD42020151002。基于模拟的教育提高了医疗保健临床医生在管理攻击行为方面的知识和信心。