Doing the right thing at the right time: assessing responses to patient deterioration in electronic simulation scenarios using course-of-action analysis

International studies indicate that the recognition and management of deteriorating patients in hospitals are poor and that patient assessment is often inadequate. Face-To-face simulation programs have been shown to have an impact on educational and clinical outcomes; however, little is known about performance in contemporary healthcare e-simulation approaches. Using data from an open-Access Web-based patient deterioration program (FIRST2ACTWeb), the performance of 367 Australian nursing students in identification of treatment priorities and clinical actions was analyzed using a military model of Course of Action Simulation Analysis. Participants performance in the whole program demonstrated a significant improvement in knowledge and skills (P =.001) with high levels of participant satisfaction. Course of Action Simulation Analysis modeling identified three key participant groupings within which only 18 took the best course of action (the right actions and timing), with most (70 ) completing the right actions but in the wrong order. The remaining 12 produced incomplete assessments and actions in an incorrect sequence. Contemporary approaches such as e-simulation do enhance educational outcomes. Measurement of performance when combined with Course of Action Simulation Analysis becomes a useful tool in the description of outcomes, an understanding of decision making, and the prediction of future events.