International Journal of Healthcare Simulation

Background:

During the second wave of the coronavirus pandemic, Day Surgery had been stopped for 6 months at Aintree University Hospital to respond to an influx of COVID patients. Day Surgery theatre staff had been redeployed to other areas of the hospital, including A&E and Intensive Care. The Day Surgery recovery had been repurposed as a ventilatory inpatient unit for coronavirus patients. We felt that this potentially jeopardized the confidence and competence of returning elective care staff. We hypothesized that the theatres themselves had become unsafe to accept patients for elective procedures having been used for a different purpose for such a long time. We used in situ simulation to re-skill the staff and test the safety of the clinical area ^[1].

Aim:

We aimed to improve the confidence and capability of theatre staff returning to work in elective theatres and to perform a systems test of the Day Surgery Unit to identify and rectify any latent errors.

Methods:

The refresher day was split into morning and afternoon sessions. The morning session comprised of two simulation sessions: cardiac arrest in recovery and a difficult airway in theatre. The afternoon comprised of sessions focussing on five anaesthetic emergencies: malignant hyperthermia, local anaesthetic toxicity, massive haemorrhage, anaphylaxis and sepsis. These sessions included locating and studying standard operating procedure (SOP) folders and locating vital equipment in the treatment of these emergencies. Participants then evaluated their confidence in managing emergencies before and after the refresher day using pre- and post-questionnaires. We also encouraged participants to raise concerns and make suggestions in a free-text section.

Results:

Forty participants took part in the refresher day. Pre- and post-questionnaires indicated that participants had much-improved confidence in dealing with anaesthetic emergencies post-session. We identified several latent errors within the unit including missing and out-of-date SOP folders, missing anaphylaxis bag, no fibrescope available for the difficult airway, no key available for the malignant hyperthermia cupboard and a poorly stocked and unsealed difficult airway trolley.

Implication for practice:

The results show that participants felt more confident to restart work in the Day Surgery Unit, hopefully improving their performance in critical incidents. By running in situ emergency simulations, we identified several latent errors in the elective care centre which allowed us to rectify these in preparation for its re-opening, improving the safety of our unit. Participants expressed a desire to engage in more simulation sessions. Latent environmental errors revealed: using in situ simulation to check the safety of returning theatres to operating after being repurposed as a ventilator inpatient unit.