International Journal of Healthcare Simulation

Background:

In situ simulation (ISS) has previously been shown to be an effective tool for identifying system issues in healthcare ^[1]. Since the commencement of weekly inter-professional ISS in the Emergency Department (ED) at Mid-Yorkshire NHS Trust in October 2020, we have run 50 ISS sessions involving 225 participants and identified several system issues. These have subsequently been addressed through debriefing, feeding learning points back to the wider department and working with the management team to resolve practical issues.

Aim:

The aim of the present study was to describe how ISS has been used to identify and address system issues in an ED setting.

Method:

Each week a simulated case is selected to address specific clinical presentations and to bring out a range of clinical and non-clinical learning points. The scenarios are run in the ED using a low-fidelity mannequin and a monitor ‘app’. The scenario is run in real time, participants are required to locate and identify real kit; medications are required to be collected and additional help/senior advice is to be sought in the way that the participants would do in normal practice. After each scenario, there is a debrief, facilitated by the ISS team, in which the participants discuss and identify learning points as well as errors and systemic issues drawing both on the scenario and wider clinical experience. These points are collated and written up in the ‘MYSIM’ (an infographic sharing learning points) and distributed through a range of channels to all ED staff. Where practical solutions are required, the team feeds these back to the relevant senior nursing staff or management team to address these issues.

Results:

Table 1 demonstrates the system issues that we have identified and addressed so far through ISS.

Table 1:

System issues identified and addressed so far through ISS

Theme	Issue	Solution
Medication	Idaricizumab unavailable in ED	Pharmacy restocked ED
Equipment	Lack of infusion pumps	ED pumps electronically tagged and returned to department
Environment	Lack of familiarity with Resus	Simulation familiarizes with environment and participants encouraged to take time to familiarize with the environment following the session
Culture	Reluctance to push the emergency buzzer	Encouraged in debriefing over several sessions’ behaviour change noted in subsequent sessions

Implications for practice:

By running ISS, we have identified and addressed a number of system issues, which, through shared learning, has seen changes within the ED and ISS continues to be a valuable tool for improving patient safety.