PG44 In-situ simulation and its use in preparation for Covid-19

Abstract

Background In-situ simulation allows for learning in the environment in which it is to be used. This allows identification of latent error, organisational challenges presented by the environment as well as providing learning opportunities for staff such as refreshing clinical knowledge and improved human factors awareness (Schofield et al, 2018). In-situ simulation can also prepare staff to more easily take up specific roles in stressful but infrequent situations such as cardiac arrest and poly trauma cases (Schofield et al, 2018). There is also evidence that people who have undergone simulation training for events like cardiac arrest have better skills in practice (Mondrup et al, 2011). We modified an existing in-situ simulation programme within our hospital to help prepare for the ongoing Covid-19 Pandemic. Summary of Work During the Covid-19 pandemic new clinical guidelines and procedures were introduced in a short space of time. We used in-situ simulation as a tool to teach new practices to staff, but also as a safe way to identify latent risk. Our two examples explored within this poster presentation include stress testing of the re-located paediatric emergency department which was moved to accommodate the new Covid-19 assessment area and a multi-speciality and interdisciplinary simulation to test cardiac arrest guidelines in a patient with Covid-19. As a result of these simulations changes to practice and organisation of the work environment were implemented to improve patient safety and care. We also identified some limitations to performing in-situ simulation during a pandemic. The loss of protected teaching time impacted simulation as staff carrying out this work had to be re-deployed clinically. During busy periods space in the department was reduced and limited the ability to perform simulation. Equipment issues also arose such as the act of simulating a Covid-19 scenario used up PPE stocks which initially were in short supply. Discussion We feel that our work shows the value of in-situ simulation in preparing hospitals for management of Covid-19 patients. It allows for the testing of new guidelines and departmental re-organisation, provides learning to staff from different disciplines and different specialities within the hospital and allows identification of latent risks. With the potential for a second wave of Covid-19 early testing of hospital preparedness using in-situ simulation to check planned guidelines and operating procedures will help to strengthen staff knowledge, increase familiarity with new policies or procedures and can highlight safety issues due to environment or equipment limitations. References Schofield, L. Welfare, E. & Mercer, S. In-situ simulation. Trauma 2018;Vol 20:p281–p288. Mondrup, F. Brabrand, M. Folkestad, L. Oxlund, J. Wiborg, K. Sand, N. & Knudsen, T. In-hospital resuscitation evaluated by in situ simulation; a prospective simulation study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2011;Vol 19:p55–p60.