International Journal of Healthcare Simulation

Background:

Optimal patient care frequently requires the safe inter-hospital transfer of critically ill patients for time-sensitive treatments, often outside of normal working hours. Safe transfer requires a multi-disciplinary approach including doctors (typically anaesthesiologists), nurses and paramedics. In a 2018 survey of anaesthesiology trainees in Ireland, 81% agreed that specific training in this area was ‘deficient’ or ‘absent’ ^[1].

Aim

Recognizing the lack of formal training, we identified the need for training in the transport of critically ill patients including familiarization with the ambulance environment and common critical transfer scenarios ^[2]. Supported by national health and education bodies, we assembled a multi-disciplinary team of clinical experts and simulation educators to develop, implement and evaluate an Adult Critical Care Transport programme (ACCT) for key healthcare professionals involved in transferring critically ill patients. Our aims were: (1) to support a shared approach across multi-disciplinary teams; (2) to provide clinical training promoting safe, efficient transfer of patients; (3) to address gaps in training of anaesthesiologists involved in transporting critically ill patients; (4) to design a course acknowledging the challenges of COVID-19, and difficulties with releasing clinical staff and faculty from work for face-to-face training.

Method/design:

The ACCT methodology consists of (1) comprehensive Video-Assisted Learning (VAL) material for pre-course completion; (2) on-site face-to-face simulation; (3) an ACCT Train the Trainer (ACCT-TTT) for trainers to subsequently deliver the programme.

Implementation outline:

The VAL material includes lectures (e.g. transport physiology), clinical skills demonstrations (e.g. transport and ambulance equipment) and simulation (e.g. safe packaging for transfer). There is an accompanying multiple-choice questionnaire (MCQ) to ensure full engagement and testing of core knowledge prior to the on-site component. On-site, small multispecialty delegate groups comprising of doctors, nurses and paramedics rotate through three simulations, allowing for enhanced experiential learning. Two take place in high-fidelity simulation laboratories, and one occurs in a fully operational ambulance. Delegates assume their real work roles and deal with common transport scenarios and adverse incidents. Debriefing focuses on reinforcing prescribed learning objectives. A post-course MCQ is used to validate learning, with feedback forms used for course evaluation. We plan to pilot the course and subsequently conduct ACCT-TTT courses. We aim to implement and expand ACCT nationwide, making it a mandatory component of anaesthesiology training.