International Journal of Healthcare Simulation

Background:

In situ simulation (ISS) has been shown to be an effective tool in delivering education to the inter-professional team in the Emergency Department (ED) ^[1]. ISS has also been utilized to drive quality improvement ^[2]. Using our local ISS programme, we provided a response to critical incidents involving patients within the ED. This has allowed identification and improvement of individual, team and system failures and has led to enhanced learning and departmental improvements to reduce risks of further incidents.

Aims:

The aim of the study was o describe how simulation has improved learning and development from critical incidents.

Method:

A simulated case is built around specific clinical incidents. Four were identified having occurred within the timeframe: missed abdominal aortic aneurysm, ischaemic limb, digoxin toxicity and ruptured ectopic pregnancy. The aim is to use ISS as a tool to educate colleagues about these presentations and as a way of checking that there are no system issues in managing such cases. Our ISS process involves either an ‘actor’ or a low-fidelity manikin with an ‘app’ providing a monitor. All equipment is sought and used in real time to attempt to simulate as close to real life as possible. The scenario utilizes junior doctors, nurses, healthcare assistants, trainee nurse associates and students. A senior team member is included if required. The participants are both briefed and debriefed, and learning points are disseminated via email placed on the ‘MYED’ Facebook group as well as the ‘MYEDSim’ ‘padlet’ page.

Results:

The ISS was run between October 2020 and May 2021. A total of 23 participants answered the nine questions on the post-ISS feedback form from the four incidents. Results are summarized in Figure 1. The participants were asked to record learning points from the sessions and suggestions for improvement. Key themes appear to be communication, team working and location of equipment in the department.

Figure 1:

Implications for practice:

By running simulations of critical incidents, we have identified deficiencies in areas within individual’s knowledge, factors shaping inter-professional team working and system failings from the wider trust which contribute to these events. This has led to wide dissemination of learning and knowledge sharing on various departmental social media/communication platforms and has allowed development and modification of clinical guidance and pathways within Mid-Yorkshire NHS Trust to reduce risks of further incidents occurring.