83 © Springer Nature Switzerland AG 2021 C. Strother et al. (eds.), Comprehensive Healthcare Simulation: Emergency Medicine, Comprehensive Healthcare Simulation, https://doi.org/10.1007/978-3-030-57367-6_8 Patient Safety Ernest E. Wang, Joanna Davidson, Clare Desmond, Jared D. Novack, Sarah Donlan, and Morris S. Kharasch Introduction Nearly 16 years have passed since the Institute of Medicine’s report: “To Err is Human,” called for a safer healthcare envi- ronment. It specifcally cited communication and teamwork as areas that required improvement and endorsed simulation as a tool to work on these areas. In the past 5 years, a signif- cant body of research has accumulated substantiating the benefts of simulation-based deliberate practice and debrief- ing. Specifcally, simulation has been shown to improve pro- vider knowledge, skill acquisition and retention, and patient safety in the clinical domain [1]. Beginning in 2012 with the initiation of the Next Accreditation System (NAS), the Accreditation Council for Graduate Medical Education (ACGME) instituted milestones-based resident assessment. The Emergency Medicine Milestones project was a collaborative initiative by the ACGME and the American Board of Emergency Medicine (ABEM) [2]. The taskforce defned 23 discrete milestones to provide a framework for the assessment of the development of the resident physician in key dimensions of physician competency. Of these, 20 are amenable to evalua- tion using simulation (Table 8.1). Moreover, the “Patient Safety” milestone specifcally evaluates residents on their acquisition of skills used in performance improvement to optimize patient safety. To date, the majority of patient safety-focused simulation research has been described in the anesthesia, critical care, obstetric, and pediatric literature, but the principles have application in emergency medicine. Here we review the cur- rent literature and suggest optimal methods to apply simula- tion in the ED to improve patient safety. 8 E. E. Wang (*) · J. Davidson · C. Desmond · J. D. Novack S. Donlan · M. S. Kharasch Division of Emergency Medicine, NorthShore University HealthSystem, Evanston, IL, USA e-mail: ewang@northshore.org Table 8.1 ACGME milestones amenable to simulation-based evaluation Emergency Stabilization (PC1) Performance of Focused History and Physical Exam (PC2) Diagnostic Studies (PC3) Diagnosis (PC4) Pharmacotherapy (PC5) Observation and Reassessment (PC6) Disposition (PC7) Multi-tasking (PC8) General Approach to Procedures (PC9) Airway Management (PC10) Anesthesia and Acute Pain Management (PC11) Other Diagnostic and Therapeutic Procedures: Vascular Access (PC14) Patient Safety (SBP1) Systems-based Management (SBP2) Technology (SBP3) Practice-based Performance Improvement (PBLI) Professional values (PROF1) Accountability (PROF2) Patient Centered Communication (ICS1) Team Management (ICS2) ACGME General Competencies: PC Patient Care, SBP Systems-based Practice, PBLI Practice-based Learning and Improvement, PROF Professionalism, ICS Interpersonal and Communication Skills