International Journal of Healthcare Simulation

Background:

In situ simulation (ISS) is an effective way to deliver inter-professional education in the Emergency Department (ED) ^[1]. Since October 2020, we have been running regular inter-professional ISS in both EDs in Mid-Yorkshire NHS Trust. We used personal experience, systems and processes from other EDs in West Yorkshire ^[2] and the literature to assist with initiating this.

Aim:

The aim of this study was to describe the process to set up an ED ISS programme and share our challenges and successes.

Method:

We run a variety of cases including paediatric and adult on a broad topic range (anything that can be seen in the ED), e.g. medical, surgical, trauma, psychiatric and maternity emergencies. We prepare the case beforehand and ensure that we have the appropriate staff and equipment. A vital aspect to ISS is ensuring the ED is safe. Embedding the attitude that this is ‘just another patient’ has been key. We use a low-fidelity manikin and a simulated monitor app. All participants are briefed, everything is in real-time to closely simulate real life. After the simulation, a debrief takes place. Feedback is sought from all and a certificate is provided. From 14 October 2020 to 5 May 2021, we have run 39 ISS with 138 inter-professional ED participants.

Results:

Figure 1 demonstrates feedback given by these participants (largely positive).

Figure 1:

Participant feedback

Implication for practice:

Although challenges exist, it is achievable and effective to run an ISS programme in a busy ED. While this was set up with the education of staff as the primary objective, it has become clear that ISS is also important in identifying system problems, testing new pathways and providing an educational response to incidents in the department.

Aspects of our programme that have worked for us include:

Picking a regular day weekly (early morning best for ED).

Having an inter-professional debriefing team helps to engage all professions.

Ensuring senior departmental support.

Build slowly to more complex simulations.

Challenges we have found are:

Changing culture/attitudes – most support simulation once they have taken part/seen it happen regularly – persevere with it!

The ED is busy – we cannot change this but can be flexible.

Too many observers put the learners off and reduce learning. We have reduced observer numbers and have a sim ‘uniform’.

Some participants have difficulty engaging with the manikin/low-grade technology – a good briefing can help.