International Journal of Healthcare Simulation

Background:

Over the last decade, research has demonstrated the positive impact of providing clinical simulation-based training (SBT) to both undergraduate students and clinical staff [1]. In-situ SBT is useful for skills improvement and team development [1]. We deliver SBT within our Intensive Care Unit (ICU) during clinical shifts. However, there are challenges to providing this education in the busy NHS environment [2]. Our aim was to address these and find solutions.

Methods:

An interdisciplinary team was formed to explore clinical simulation within a 20 bedded ICU. Our ICU is within a large inner-city teaching hospital, employing over 100 nurses and 14 consultants.

We deliver scenario-based simulation during clinical shifts with members of the interprofessional team. Scenarios include: unplanned extubation and major haemorrhage [3]. Evaluation of sessions is undertaken through anonymous questionnaires of those involved in the SBT. PDSA (Plan, Do, Study, Act) cycles have been adopted to test the change and improve delivery.

Results:

To date, 16 sessions have been carried out (from July 2018) involving a total of 51 members of the interprofessional team. Evaluation response rates are 100% (n= 51). These sessions have proven popular with staff, with feedback such as: ‘Learning under stress has helped me focus more, especially as it is a safe environment.’ Staff welcomed the opportunity to undertake this training in the ‘real’ clinical environment.

Challenges included risk of delay in care to our patients, increased unit workload, and establishing and maintaining a circle of trust. However, senior team ‘buy in’ has enabled sessions, consequently demonstrating the value placed in SBT. The COVID-19 pandemic created significant critical care skills gap. In-situ SBT addressed this by bringing teams together to explore cross-discipline working within the real clinical environment.

Conclusion:

We have demonstrated that the delivery of this type of education is safe and effective, and staff found it useful and accessible. Feedback suggests the impact of SBT alongside traditional competency-based teaching is beneficial in achieving different educational goals. In-situ simulation ideally enables a team of experts to become an expert team. Having a simulation champion to promote in-situ within the unit and demonstrate a return in investment to senior managers and participants of effort and time against clear educational goals for critical care.

References

1. Martin A, Cross S, Attoe C. The use of in situ simulation in healthcare education: current perspectives. Advances in Medical Education and Practice. 2020;11:893–903.

2. Stroud JM, Jenkins KD, Bhandary SP, Papadimos TJ. Putting the pieces together: the role of multidisciplinary simulation in medical education. International Journal of Academic Medicine. 2017;3(1):104–109.

3. Patterson MD, Geis GL, Falcone RA, LeMaster T, Wears RL. In situ simulation: detection of safety threats and teamwork training in a high-risk emergency department. BMJ Quality & Safety. 2013;22(6):468–477.