International Journal of Healthcare Simulation

Background:

The SCOOP protocol [1] for emergency management of post-operative neck haematoma was devised in Oxford in 2019 in response to learning from a critical incident [2]. It has now been nationally recognised [1]. Oxford University Hospitals (OUH) NHS Foundation Trust is an acute tertiary centre providing neck surgery at three distinct sites. In 2019, the Oxford Simulation Training and Research (OxSTAR) group devised an innovative multidisciplinary simulation-based educational programme based on the SCOOP protocol for members of the perioperative team caring for patients receiving neck surgery. It aimed to ensure OUH staff were skilled and equipped to respond to this rare, but life-threatening complication in their own work environments.

Activity:

The course has four major components (Figure 1):

Figure 1:

Illustration of the SCOOP course

1. Lecture: anatomy and clinical context.

2. Group discussion: team members discuss their local experience.

3. Part-task trainer: putting theory into practice using a simple, re-usable and easy to construct tool.

4. High-fidelity simulation: multidisciplinary teamwork and structured debriefing navigating the human factors and decision-making process.

Results:

50 OUH team members across 3 sites attended and provided feedback. Attendees have praised the course for its multidisciplinary nature, attracting staff from nursing, medical, and theatre backgrounds. Feedback has shown that team members have particularly appreciated tackling scenarios in their usual clinical teams. 96% strongly agreed that the course helped them understand the required actions for the management of a neck haematoma – numeric rating scale (NRS) score of 9–10/10. 98% strongly agreed that simulation was helpful in their learning experience – (NRS) score 9–10/10.

Comments demonstrated the strength of the course format:

‘Incredibly useful course and importantly gives use the confidence to make that crucial decision to SCOOP’

‘The practical part of the training was very helpful for me: I feel more confident to do SCOOP and is good to know all the steps and why I have to do it’

Conclusion:

The value of this format is shown in the results above and in the actions of the attendees during/after the course. Group discussions allowed attendees to raise specific departmental or institutional factors impacting SCOOP implementation allowing faculty to raise issues directly to clinical leaders and Trust management. Team leaders attending felt motivated to check their local clinical environments and teach others. The course inspired an attendee to lead tea-trolley for their colleagues who had been unable to attend. This course format could be considered nationally by centres looking to improve patient safety.

References

1. Iliff HA, El‐Boghdadly K, Ahmad I, Davis J, Harris A, Khan S, Lan‐Pak‐Kee V, O’Connor J, Powell L, Rees G, Tatla TS. Management of haematoma after thyroid surgery: systematic review and multidisciplinary consensus guidelines from the Difficult Airway Society, the British Association of Endocrine and Thyroid Surgeons and the British Association of Otorhinolaryngology, Head and Neck Surgery. Anaesthesia. 2022 Jan;77(1):82–95.

2. Oxford University Hospitals NHS Foundation Trust. Learning from Deaths. TB2019.50, 2019. https://www.ouh.nhs.uk/about/trust-board/2019/may/documents/TB2019.50-learning-from-deaths.pdf [Accessed on 20/06/2022]