International Journal of Healthcare Simulation

Background:

In situ simulation (ISS) is an effective educational tool that improves patient safety outcomes ^[1]. It has been trialled previously in this trust but not regularly and many staff members had never participated. Anticipated challenges included freeing staff from clinical duties, scepticism about simulation training and technical issues.

Aim:

The aim of the study was to establish a regular programme of inter-professional ISS delivered by a dedicated team in the emergency department (ED).

Method:

An ED simulation team was created, including consultants, a senior registrar and two newly appointed simulation junior clinical fellows. Sessions run monthly in both EDs in the trust, taking place in the ‘green’ resus area, in the morning when clinical demand is usually lowest. Participants include doctors and nursing staff of all grades, with cross-speciality involvement. Increasing participation required was influenced by senior management and clinical staff agreeing this was a necessary and valuable tool. Faculty include the ED simulation team and a simulation technician. Scenarios are developed by the team with specific intended learning outcomes, e.g. ALS in COVID-19, assessment of the acutely unwell pregnant patient. Intended learning outcomes are influenced by new guidelines, specific emergency cases or skills and suggestions by staff. The patient has been trialled as an actor and/or SimMan3G, depending on the scenario. Clinical equipment is mostly donated and expired. A structured debrief is led by a senior simulation team member. Key learning from each session is summarized in a ‘Sim News’ poster which is tweeted, disseminated via email to all staff and published on the departmental ‘EMBeds’ website. Participants fill in an anonymous feedback form online and receive a certificate of participation.

Results:

Fifty-nine participants from December 2020 to April 2021 gave feedback (see Table 1). Comments included ‘…helped me learn my anaphylaxis protocol’, ‘Teamwork and communication are vital’.

Table 1:

Feedback form results

This simulation session…	Average score (10 – strongly agree, 1 – strongly disagree)
…improved my clinical knowledge	9.63
…made me more familiar with my working environment	9.58
…taught me about current guidelines	9.68
…helped me improve my team working	9.84
…helped me improve my leadership skills	9.21
…helped me improve my communication skills	9.53
I enjoyed this simulation session	9.74
I would feel more confident managing a similar situation in the future	9.58
Simulation is a valuable tool in my training	9.74

Implications for practice:

The in situ programme has successfully educated staff; led to changes in guidelines published on ‘EMBeds’; and identified and corrected problems relating to the clinical environment. Staff have found it an enjoyable and valuable experience. The next steps are to increase the frequency of sessions, expand faculty to include a paid senior staff member and include further clinical teams such as blood bank, trauma team and other specialities.