LO81: The use of in situ simulation to improve emergency department staff comfort with the management of high acuity, low occurrence cases

Introduction: In the emergency department (ED), high-acuity presentations encountered at low frequencies are associated with reduced staff comfort. Previous studies have shown that simulation can improve provider confidence with practical skills and management of presentations in various fields of medicine. The present study examined the effect of in situ simulation on interprofessional provider comfort with the identification and management of high-acuity low-frequency events in the ED. It further assessed the feasibility of implementing weekly simulation as an interprofessional education initiative in a high-volume ED. Methods: This was a retrospective pre-test post-test quasi-experimental design. Weekly in situ simulation events were facilitated by an interdisciplinary team in a high-volume ED in Hamilton, Ontario that sees an average of 185 patients per day. To date, 34 simulation events were held between January 18, 2019 and November 22, 2019, and included neonatal, paediatric and obstetric emergencies, and adult codes. There was an average of 20 patients presenting to the ED during these events. Events included a debrief, and typically lasted 60 minutes in total. Participants included individuals from various disciplines working on shift at the time of the event. Questionnaires were administered via email following the event, in which participants were asked to rank their comfort with emergency codes before and after the simulation using two 5-point Likert scales. The data from 39 questionnaires was analyzed. T-tests were used to analyze differences in self-reported comfort scores. Results: Questionnaire responders included nurses (41%), respiratory therapists (26%), resident physicians (10%), paramedics (3%), attending physicians (3%), students of various disciplines (10%) and other (7%). 38% of participants reported increases in comfort following simulation when compared to prior. Using the 5-point scale, the average reported score for comfort pre-simulation was 3.59 (95% CI 3.30–3.88), and the average post-simulation score was 3.97 (95% CI 3.76–4.19, p = 0.03). Conclusion: Our results demonstrate that weekly interprofessional in situ simulation is feasible in a high-volume ED, and significantly improves self-reported provider comfort with the identification and management of high-acuity, low-frequency events. This warrants the implementation of this simulation design to improve staff confidence and has implications for its potential role in improving team dynamics and patient safety.

Download Full-text

An In Situ Simulation-Based Training Approach to Active Shooter Response in the Emergency Department

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2018.39 ◽

2018 ◽

Vol 13 (02) ◽

pp. 345-352 ◽

Cited By ~ 1

Author(s):

Mark S. Mannenbach ◽

Carol J. Fahje ◽

Kharmene L. Sunga ◽

Matthew D. Sztajnkrycer

Keyword(s):

Emergency Department ◽

Emergency Departments ◽

Low Frequency ◽

Training Model ◽

The United States ◽

Lessons Learned ◽

Added Value ◽

Active Shooter ◽

In Situ Simulation

ABSTRACTWith an increased number of active shooter events in the United States, emergency departments are challenged to ensure preparedness for these low frequency but high stakes events. Engagement of all emergency department personnel can be very challenging due to a variety of barriers. This article describes the use of an in situ simulation training model as a component of active shooter education in one emergency department. The educational tool was intentionally developed to be multidisciplinary in planning and involvement, to avoid interference with patient care and to be completed in the true footprint of the work space of the participants. Feedback from the participants was overwhelmingly positive both in terms of added value and avoidance of creating secondary emotional or psychological stress. The specific barriers and methods to overcome implementation are outlined. Although the approach was used in only one department, the approach and lessons learned can be applied to other emergency departments in their planning and preparation. (Disaster Med Public Health Preparedness. 2019;13:345–352)

Download Full-text

A Guide for Medical Educators: How to Design and Implement In Situ Simulation in an Academic Emergency Department to Support Interprofessional Education

Cureus ◽

10.7759/cureus.14965 ◽

2021 ◽

Author(s):

Derek L Monette ◽

Daniel D Hegg ◽

Angela Chyn ◽

James A Gordon ◽

James K Takayesu

Keyword(s):

Emergency Department ◽

Interprofessional Education ◽

In Situ Simulation ◽

Medical Educators

Download Full-text

In Situ Simulation to Mitigate Threats to Participation in a Multicenter Clinical Trial in High-Acuity, Low-Frequency Setting

Simulation in Healthcare The Journal of the Society for Simulation in Healthcare ◽

10.1097/sih.0000000000000328 ◽

2019 ◽

Vol 14 (1) ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Steven Chan ◽

Lynn Babcock ◽

Gary Geis ◽

Mary Frey ◽

Venita Robinson ◽

...

Keyword(s):

Clinical Trial ◽

Low Frequency ◽

Multicenter Clinical Trial ◽

In Situ Simulation ◽

High Acuity

Download Full-text

P112: In situ simulation: A team sport?

CJEM ◽

10.1017/cem.2019.303 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S104

Author(s):

D. Rusiecki ◽

S. Hoffe ◽

M. Walker ◽

J. Reid ◽

N. Rocca ◽

...

Keyword(s):

Emergency Department ◽

Team Sport ◽

Multidisciplinary Teams ◽

Clinical Environment ◽

Respiratory Therapist ◽

In Situ Simulation ◽

Kingston General Hospital ◽

High Acuity ◽

Survey Responses

Introduction: Identification of latent safety threats (LSTs) in the emergency department is an important aspect of quality improvement that can lead to improved patient care. In situ simulation (ISS) takes place in the real clinical environment and multidisciplinary teams can participate in diverse high acuity scenarios to identify LSTs. The purpose of this study is to examine the influence that the profession of the participant (i.e. physician, registered nurse, or respiratory therapist) has on the identification of LSTs during ISS. Methods: Six resuscitation- based adult and pediatric simulated scenarios were developed and delivered to multidisciplinary teams in the Kingston General Hospital ED. Each ISS session consisted of a 10- minute scenario, followed by 3-minutes of individual survey completion and a 7- minute group debrief led by ISS facilitators. An objective assessor recorded LSTs identified during each debrief. Surveys were completed prior to debrief to reduce response bias. Data was collected on participant demographics and perceived LSTs classified in the following categories: medication; equipment; resources and staffing; teamwork and communication; or other. Two reviewers evaluated survey responses and debrief notes to formulate a list of unique LSTs across scenarios and professions. The overall number and type of LSTs from surveys was identified and stratified by health care provider. Results: Thirteen ISS sessions were conducted with a total of 59 participants. Thirty- four unique LSTs (8 medication, 15 equipment, 5 resource, 4 communication, and 2 miscellaneous issues) were identified from surveys and debrief notes. Overall, MDs (n = 12) reported 19 LSTss (n = 41) reported 77 LSTs, and RTs (n = 6) reported 4 LSTs based on individual survey data. The most commonly identified category of LSTs reported by MDs (36.8%) and RTs (75%) was equipment issues while RNs most commonly identified medication issues (36.4%). Participants with □5 years of experience in their profession, on average identified more LSTs in surveys than participants with >5 years experience (1.9 LSTs vs 1.5 LSTs respectively). Conclusion: Nursing staff identified the highest number of LSTs across all categories. There was fairly unanimous identification of major LSTs across professions, however each profession did identify unique perspectives on LSTs in survey responses. ISS programs with the purpose of LST identification would benefit from multidisciplinary participation.

Download Full-text

LO044: Stress-testing the resuscitation room: latent threats to patient safety identified during interprofessional in-situ simulation in the emergency department

CJEM ◽

10.1017/cem.2016.81 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S45-S45

Author(s):

G. Mastoras ◽

C. Poulin ◽

L. Norman ◽

B. Weitzman ◽

A. Pozgay ◽

...

Keyword(s):

Emergency Department ◽

Patient Safety ◽

Interprofessional Education ◽

Healthcare Professionals ◽

Tertiary Care ◽

Healthcare Team ◽

Monthly Basis ◽

In Situ Simulation ◽

Training Tool

Introduction: Emergency Department (ED) resuscitation is a complex, high-stakes procedure where positive outcomes depend upon effective interactions between the healthcare team, the patient, and the environment. To this end, resuscitation teams work in spaces designed to optimize workflows and ensure that necessary treatments and skillsets are available when required. However, systematic failures in this environment cannot always be adequately anticipated, exposing patients to opportunities for harm. As part of a new interprofessional education initiative, this prospective, observational study sought to characterize latent threats to patient safety (LST’s) identified during the delivery of in-situ, simulated resuscitations in two Canadian, tertiary care, academic Emergency Departments. Methods: In-situ simulation sessions were delivered on a monthly basis in the EDs of each hospital campus, during which a variety of simulated resuscitation scenarios were run with distinct teams of ED healthcare professionals. A research assistant was present throughout each session and documented LST’s identified by simulation facilitators and participants during the case and debriefing. Data were entered into a master table and grouped thematically for analysis. Results: After a pilot run-in, 10 in-situ simulation sessions were delivered, involving 27 cases and reaching 180 ED healthcare professionals (25 attending MD, 37 resident MD, 59 RN, 24 RT). 83 latent safety threats were identified through these sessions (mean 3.1 LSTs per case) of which 52 were determined to be “actionable”. Corrective mechanisms have been initiated in 72% of these cases (e.g., new education campaigns and in-servicing, equipment provisioning, equipment checklists). Conclusion: In-situ simulation, beyond its role as a training tool for developing Non-Technical and Crisis Resource Management skills, can be effectively used to identify systematic deficits and knowledge gaps that could expose critically ill patients to harm. Effective quality improvement and continuing education programs are essential to translate these findings into more resilient patient care.

Download Full-text

SP10.1.7 The Important Role of In-Situ Simulation in Preparing Surgeons for the COVID-19 Pandemic

British Journal of Surgery ◽

10.1093/bjs/znab361.180 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Pierre Montauban ◽

Charannya Balakumar ◽

Jaideep Rait ◽

Prizzi Zarsadias ◽

Sara Iqbal ◽

...

Keyword(s):

High Risk ◽

In Situ Simulation ◽

Level Of Confidence ◽

Effective Training ◽

Before And After ◽

Quasi Experimental ◽

Surgical Teams ◽

Imminent Threat ◽

The Impact

Abstract Background Effective training is vital when facing viral outbreaks such as the SARS Coronavirus 2 (SARS-CoV-2) outbreak of 2019. The objective of this study was to measure the impact of in-situ simulation on the confidence of the surgical teams of two hospitals in assessing and managing acutely unwell surgical patients who are high-risk or confirmed to have COVID-19. Methods This was a quasi-experimental study with a pretest-posttest design. The surgical teams at each hospital participated in multi-disciplinary simulation sessions to explore the assessment and management of a patient requiring emergency surgery who is high risk for COVID-19. The participants were surveyed before and after receiving simulation training to determine their level of confidence on a Visual Analog Scale (VAS) for the premise stated in each of the nine questions in the survey, which represented multiple aspects of the care of these patients. Results 27 participants responded the pre-simulation survey and 24 the one post-simulation. The level of confidence (VAS score) were statistically significantly higher for all nine questions after the simulation. Specific themes were identified for further training and changes in policy. Conclusion In-situ simulation is an effective training method. Its versatility allows it to be set up quickly as rapid-response training in the face of an imminent threat. In this study, it improved the preparedness of two surgical teams for the challenges of the COVID-19 pandemic.

Download Full-text