Default RSS Feed en-us Adi Health + Wellness <![CDATA[]]> /article/doi/10.54531/EEIC5466 IntroductionThe COVID-19 pandemic has affected gynaecology trainees in the United Kingdom by reducing operating theatre experience. Simulators are widely used for operative laparoscopy but not for practising laparoscopic-entry techniques. We devised a low-cost simulator to help trainees achieve the skill. Our aim was to pilot this low-cost simulator to perform Royal College of Obstetricians and Gynaecologists (RCOG) supervised learning events.

Methods

A single-centre pilot study involving six gynaecology trainees in a structured training session. Interactive PowerPoint teaching was followed by trainees’ demonstration of laparoscopic entry for a supervised learning event and personalized feedback. Participants completed pre- and post-course questionnaires.

Results

All the trainees found the training useful to the score of 10 (scale of 1–10) and recommended this to be included in Deanery teaching. Personalized feedback was described as the most useful. The simulator was rated as good as a real-life patient relative to the skill being taught.

Discussion

Gynaecology trainees are affected by lack of hands-on experience in the operating theatre for performing laparoscopic entry. A low-cost abdominal laparoscopy entry simulator can help deliver the RCOG curriculum, enabling trainees to achieve required competencies. ]]>
<![CDATA[]]> /article/doi/10.54531/TTAC2270 Background:Even in the presence of established institutional guidelines, failure of compliance by the clinical teams plays an important role in the control of diabetes. The identified gaps include contextual and biomedical knowledge, attitudes, clinical inertia, confidence and familiarity with existing hospital resources and guidelines with regards to hospital diabetes care [1].

Aim:

We wanted to demonstrate the efficacy of low-dose high-frequency in situ simulation exercises through a pilot study in a ward setting to improve outcomes in patients with diabetes.

Simulation activity outline:

The exercise was a 15-minute session, delivered during working hours to individual nurses. This consisted of a 5-minute scenario, involving a standardized patient followed by a 10-minute debrief. Modified Diamond-model debrief with an advocacy-inquiry model was used by the debriefer, a trained fellow in simulation, and overseen by an expert. The scripted scenario involved a patient with Diabetic Ketoacidosis (DKA), with learning outcomes of recognizing DKA, managing the patient and adhering to the institutional guidelines including management of hypoglycaemia. The scenario was individualized based on the roles of the participants. Pre- and post-questionnaires were given to the participants. The simulation was repeated twice in the second week and once in the third week.

Methodology:

This mixed-method study was conducted in a UK teaching hospital, in a ward designated for patients with diabetes, as a part of a quality improvement programme. In the first week, patients with diabetes, admitted for DKA, were chosen and their blood sugar recordings, dysglycaemic episodes and adherence to guidelines were noted. Every week data were collected as in the first week. GNU pspp 1.0.1 [version 3] free software was used. The confidence scores were given as mean and standard deviation with confidence interval (CI) of 98.75%. A p-value of <0.0125 was considered significant based on the number of data points.

Results:

The in situ simulation was delivered to a total of nine ward staff. There was a significant improvement in the confidence levels at the end of the session. The number of blood sugar recordings were 1.4 per person-days in the first week, 2.07 in the second week and 3.6 in the third week (Table 1). Hypoglycaemic episodes correctly identified were 4.76%, 6.9% and 14.29% in the 3 weeks, respectively. Sugars >14 mmol/L were identified 28.57%, 37.93% and 57.14%, respectively, for the 3 weeks. Qualitative analysis showed protocol adherence issues and latent medication errors in addition to positive changes with regards to handover and diagnosis of hypoglycaemia.Table 1:Dysglycemic episodes and protocol adherence from medical recordsWeekAge/
SexPatientDaysNumber of samplinghypoglycaemic episodeshyperglycaemic episodesTreatment for hypoglycaemia as per protocolProtocol adherence once sampled140/F15913NoYes28/F24502NANo29/F33301NANo71/M43400NANo264/M52300NANo72/M6618010NANo31/F72310NoYes70/M83301NANo73/M91210YesNo339/F102713YesYes68/M112600NAYes77/M1241535YesYes30/F132808NAYes

Implication for practice:

Considering the T2 (increased recognition of diabetic emergencies and adherence to protocol) and T3 (improved patient outcomes) outcomes, the methodology was recommended as a modality of training the nursing staff involved in inpatient care of patients with diabetes. Future programmes including multi-disciplinary teams, to explore teamwork and communication, are planned. ]]>
<![CDATA[]]> /article/doi/10.54531/UDZB8526 Background:Clinical reasoning is interconnected with decision-making which is a critical element to ensure patient safety [1]. To avoid practice mistakes, healthcare professionals should be competent with effective clinical reasoning skills. To develop effective clinical reasoning skills, healthcare professionals should get the chance to practise and be exposed to various experiences and levels of patient complexities. Simulation can immerse learners in scenarios that mimic clinical situations, simultaneously mitigating safety risks and increasing standardization in healthcare education [2]. Through simulation, learners can get the chance to practise clinical reasoning with focussed learning opportunities [3]. Several assessment tools have been used to measure clinical reasoning while attending simulation-based activities. However, we would like to explore the most valid and reliable tools to assess clinical reasoning while attending simulation, in addition to finding out whether these tools have considered the seniority and competency levels of their users.

Method:

A scoping review was undertaken to answer the questions: What are the best available valid and reliable tools to evaluate clinical reasoning while attending simulation-based activities? Do we have valid and reliable clinical reasoning assessment tools for simulation that measure clinical reasoning considering different seniority and competency levels? We searched Medline, Scopus, Education Research Complete, and Google Scholar to identify relevant recent primary research conducted on this topic from 2000 onwards. The search included MeSH topics of: ‘Clinical reasoning’, ‘Simulation-based courses’ and ‘Clinical Reasoning tools’. The inclusion criteria were primary studies that described the use of tools measuring clinical reasoning while attending simulation-based courses. Two independent researchers agreed on the inclusion of the identified papers for full-text review. This review followed the review guidelines of Joanne Briggs institute.

Findings:

There are valid and reliable tools to evaluate clinical reasoning while attending simulation which is Clinical Reasoning Evaluation Simulation Tool CREST [1]; 
Lasater Clinical Judgment Rubric LCJR [4]; Creighton Competency Evaluation Instrument Creighton C-SEI- Tool [5]. 
However, the validity and reliability of these tools were tested on undergraduate student nurses, and there was no consideration for different seniority and competence levels, and applicability to other healthcare professions.

Implications for practice:

There is an adequate number of tools to measure clinical reasoning while attending simulation. However, there is a significant basis to test the reliability and validity of these tools against different competence and seniority levels, and applicability to other healthcare professions. ]]>
<![CDATA[]]> /article/doi/10.54531/LBRR5359 Background:The community outreach programme paused during the global pandemic as schools were closed and we were unable to go into schools and colleges to use simulation-based training to educate and inspire young adults to consider a career in the National Health Service. Now that schools and colleges are open it is still difficult to go into schools and colleges due to COVID-19 restrictions. We needed a way to continue to reach out to these schools and colleges using simulation to educate and inspire young adults.

Aim:

The aim was to continue the outreach programme but virtually, via live streams and some pre-recorded simulations. Aiming to help to increase awareness of the different careers, routes into the National Health Service and skills required to work in healthcare. ‘A virtual learning environment is intended not simply to reproduce a classroom environment -’on-line’, but to use the technology to provide a new way of learning’, Britain and Liber [1]. By continuing to provide the outreach simulation project I hope to be able to engage with a larger number of learners at a single time.

Method/design:

Streaming live simulations sessions with tutor groups from schools and colleges via platforms such as Microsoft Teams and Zoom using a variety of simulation scenarios. These simulations will be mainly focussing on human factors with some teaching on specific subjects depending on the need of the learners. Example: Virtual work experience for young adults interested in medicine. We plan to mock up our simulation centre to replicate an accident and emergency department and have three admissions of different severity. We will be streaming this to two schools simultaneously and they will have the chance to help prioritize the three patients and explain their choice. The simulations will display good teamwork, good communications skills and leadership. One of the simulations will not include these skills and display poor communication, this will be intentionally included in a simulation for the learners to identify.

Implementation outline:

Feedback forms will be given to all learners to complete asking them if the session has inspired them to consider a career in the National Health Service, feedback will then be used to adjust the way we deliver the virtual side of the outreach programme and perfect the programme so we can continue to educate and inspire young adults. ]]>
<![CDATA[]]> /article/doi/10.54531/JBXJ4450 Background:The large-scale relocation of a paediatric hospital is a significant undertaking. New environments change the system, and ways of working must adapt to maintain quality healthcare. There are risks to patients and staff well-being, with high anxiety around change. There is evidence for the efficacy of simulation as a tool for safe training and rehearsal of staff and teams [1] but less so on such a large scale. Simulation for many is still perceived as a test of performance and a threat. We connected with the international simulation community to design a hospital-wide programme of Patient Environment Simulations for Systems Integration (PESSI). This paper outlines challenges in establishing buy-in from stakeholders and departments, developing a framework for implementation and our reflections on delivery of large-scale simulation activities to assist a hospital move.

Aims:

How can simulation-based methodology be used to support clinical departments on a large scale to adapt/integrate/prepare in moving to a brand-new hospital?

Method/design:

Collaboration with authors of PEARLS for system integration use [1], using it as the main framework for delivery and structure of PESSI. Stages of delivery were: pre-phase work, system testing day, debrief/reflection and evaluation. Immediate feedback of enjoyment and learning was collated from all participants. Three-month post-move feedback is planned to review ongoing impact/behaviour change plus analysis of safety incidents.

Implementation outline:

Pre-phase work involved meeting stakeholders and establishing aims of testing. Ward managers were key departmental links, meeting with members of PESSI to plan scenarios. System testing days involved familiarizing themselves with the environment, followed by ‘day in the life’ simulations with a representation of the whole team. All participants were called ‘co-faculty’ and knew exactly what would happen. Debrief involved facilitated conversations with the whole team describing reactions, and deeper analysis of the key events, with concerted efforts by facilitators to give a balanced approach of positives and challenges. A short report was given back to the department detailing the findings teams would need solutions to. Solutions from simulation were implemented prior to the move, increasing staff confidence, with many feeling PESSI played a major role in feeling prepared for the new site. The PESSI framework is being utilized in adult services and we hope to publish our methodology to share with the wider simulation community. ]]>
<![CDATA[]]> /article/doi/10.54531/FQAX8042 IntroductionEffective teamwork remains a crucial component in providing high-quality care to patients in today’s complex healthcare environment. A prevalent ‘us’ versus ‘them’ mentality among professions, however, impedes reliable team function in the clinical setting. More importantly, its corrosive influence extends to health professional students who model the ineffective behaviour as they learn from practicing clinicians. Simulation-based training (SBT) of health professional students in team-based competencies recognized to improve performance could potentially mitigate such negative influences. This quasi-experimental prospective study will evaluate the effectiveness and impact of incorporating a multi-year, health science centre-wide SBT curriculum for interprofessional student teams. It targets health professional students from the Schools of Medicine, Nursing and Allied Health at Louisiana State University (LSU) Health New Orleans.

Methods and analysis

The intervention will teach interprofessional student teams key team-based competencies for highly reliable team behaviour using SBT. The study will use the Kirkpatrick framework to evaluate training effectiveness. Primary outcomes will focus on the impact of the training on immediate improvements in team-based skills and attitudes (Level 2). Secondary outcomes include students’ perception of the SBT (Level 1), its immediate impact on attitudes towards interprofessional education (Level 2) and its impact on team-based attitudes over time (Level 3).

Ethics and dissemination

The Institutional Review Board at LSU Health New Orleans approved this research as part of an exempt protocol with a waiver of documentation of informed consent due to its educational nature. The research description for participants provides information on the nature of the project, privacy, dissemination of results and opting out of the research. ]]>
<![CDATA[]]> /article/doi/10.54531/CADQ3440 Background:Simulation-based education (SBE) is often celebrated as a safe learning environment, but this usually refers to the risk posed to patients, in this literature review the psychological safety for participants and the elements of SBE that generate or reduce stress are sought. Stress and learning have a complex relationship in adult learning; however, negative stress may inhibit memory formation and so the sustainable effect of SBE learning may be jeopardized by participants experiencing unnecessary stress during SBE. It is therefore important to identify the nature and trigger for stress in SBE to optimize this resource.

Method:

Using the online database PubMed and the search terms (stress and anxiety) AND (Simulation) AND ((clinical education, medical education)) without limits on publication type or date, 20 articles were returned. A non-systematic review was undertaken. Articles that were designed to deliberately introduce stress into SMEs to gauge the effect on performance were excluded. Included studies analysed the type, characteristics and potential triggers of stress evoked through participation in SBE. 17 studies were retained.

Findings:

No studies in the UK were returned, SBE participants were from undergraduate and post-graduate settings and there was a mixture of professional groups included with three studies looking at team-based SMEs. Study design and method varied with an observational study being the most common method. Only one looked at qualitative data from focus groups of SME participants. Nearly all studies recorded a physical marker of stress – heart rate, cortisol level or visible signs of stress such as shaking hands. Two studies looked at techniques to actively reduce stress within the SBE activity; a mindfulness exercise before a task-based simulation and an introduction of a period of relaxation prior to debriefing. Faculty awareness of participant stress was measured objectively in only one study. SME design and equipment stressors were directly considered in two studies.

Implications for practice:

There are limited dedicated studies addressing SBE-induced stress and how this can be modified; furthermore, a lack of research into faculty impact on stress hinders the opportunity to change. This was not a systematic literature review and so the findings are limited, but can help inform practitioners: (1) Repeated exposure and familiarity with SME reduce stress. (2) Designate roles that participants would be expected to undertake in real clinical scenarios. (3) Minimize distracting factors in the environment unless directly contributing to learning outcome. (4) Introducing a purposeful period of calm before debriefing may improve retention of learning outcomes. ]]>
<![CDATA[]]> /article/doi/10.54531/MKXW2760 Background:Within a rural county, student placement locations are geographically scattered. Student feedback revealed that only students in one placement were able to benefit from the high-fidelity simulation suite resources situated at the lead hospital. Research shows students value co-created and personalized resources. Working with our practice partners we identified a cost-effective, accessible and inclusive solution, using 360 videos. Clinical simulation has been found to be effective [1] for teaching nursing skills. One limitation is the number of participants who can be involved at one time and in one place. A pilot study [2], with nursing students (n = 217), using low-cost virtual reality headsets, demonstrated that learning via immersive approaches aided understanding of the complex concepts, provided immediate feedback about clinical decisions, and could be completed multiple times. It provided additional opportunities for safe practice and complimented their ward and clinical skills experiences. Simulation technicians and lecturing staff recognized these benefits but identified time and cost constraints as challenges. Building on this research, we designed and evaluated a small-scale pilot to improve processes.

Aim:

To use 360 videos accessed via low-cost VR headsets to scale the clinical simulation experience for paediatric nursing students.

Method/design:

Working with our local hospital and our second-year paediatric nursing students, we used agile design methods and co-creation to develop two ABCDE assessment clinical simulations (sepsis and acute respiratory illness), using a 360 camera. These videos were accessed using low-cost virtual reality headsets, Oculus Quest™, mobile devices and Microsoft HoloLens™. Qualitative evaluation sought views of students, nursing staff/academics and simulation technicians through focus groups (n = 10). Thematic analysis revealed emergent themes of flexibility of access, repetition of learning opportunity and strengthening or the practice-theory link. Challenges included user familiarity with the technology and time investment. The main impact of this project was wider and longer-lasting learning compared with traditional methods.

Implementation outline:

Bite size learning chunks embedded strategically into our new nursing curriculum, for 300 student nurses studying at level 5. Harnessing the full potential of the clinical simulated experience permits students and staff to learn at a time and place of their own choosing. The ABCDE assessment will be expertly demonstrated through 360 videos, which will better prepare students for in-person simulations, saving face-to-face time explaining how to carry out the simulation. Learning from this project will feedforward to a faculty-wide multi-disciplinary clinical simulation event, informing guidelines. ]]>
<![CDATA[]]> /article/doi/10.54531/PXGQ8394 Background:The newly built Women’s Wellness and Research Center (WWRC) replaced the pre-existing Women’s Hospital (WH) as the only provider of tertiary maternity care for the residents of Qatar. The pre-existing WH was smaller, with a 12-bay emergency department, 3 operating theatres, 12 delivery rooms and 220 beds, in shared rooms. The new WWRC facility is significantly bigger, with a 28-bay emergency department, 7 operating theatres over two floors, 26 delivery rooms and 240 private inpatient rooms catering for around 18,000 deliveries per year. New systems, designed over only a few months, would need to promote that same level of high-quality patient care but in a newer, larger and unfamiliar facility.

Aims:

The aim of the study was to identify and mitigate clinical systems risks, relevant to anaesthesia services, by running in situ simulations.

Method:

The ‘WWRC Anesthesia Activation Team’ was established to conduct in situ simulations, testing clinical systems. We hypothesized that, despite meticulous planning, numerous process gaps would be discovered, and that improvements derived from testing sessions would reduce risk [1]. Well-planned scripted ‘everyday’ scenarios were prepared. Relevant multi-disciplinary groups of participants were involved, and the scenarios were kept flexible. After the simulation, facilitated debriefing highlighted problem areas and suggested improvements.

Implementation outline:

Approximately 110 hours of simulation were conducted in sites relevant to anaesthesia. Many of the participants had never experienced simulation before but nearly everybody complimented its usefulness and debriefing was unanimously constructive. Testing identified 143 discrete latent safety threats (LST) and were categorized under Facility, Workflow, Personnel, Process, Equipment and Technology (Table 1). Fifty-four LSTs were due to systems that were incomplete at the time of testing but would be completed by the time services commenced. The remaining 89 were significant LSTs which could have resulted in significant clinical incidents. After mitigation of LSTs, the areas were simulation tested again to confirm threat elimination. WWRC was opened only after all areas of concern were addressed. A year after moving, a review of all the changes recommended from the simulation-based systems testing was conducted. It showed that there were no anaesthesia-related clinical incidents in those areas.Table 1:CategoriesNumber 
of LST (89)ExamplesFacility9Theatre recovery was too congested to deal with any emergencies involving mother or baby – layout was changed, and equipment rearranged to create more space for essential staff and equipmentWorkflow11Patient pathway, in and out of theatre was not compliant with infection control recommendations – pathway was changed, sterile and non-sterile areas were clearly marked to meet strict recommendationsPersonnel5Number of anaesthetists on-call was insufficient to cover multiple sites within the hospital – the on-call anaesthetist numbers were increased and working pattern made more efficientProcesses26Blood bank was located far from theatres resulting in significant delays in procuring blood – blood processing and procurement process were modified to reduce delaysEquipment34Multiple items identified as either faulty/incompatible/missing were removed or replaced by new onesTechnology4Paging system was inefficient and emergency calls were missed –existing system scrapped, and new system installed to ensure reliable communication.Our experience confirms that simulation can identify Latent Safety Threats (LST) prior to a major move to a new facility [2]; 
the team identified problems that had not been identified by existing committees. Scenario-based clinical systems testing allowed for pre-emptive process optimization and risk mitigation thereby improving patient safety, quality and staff preparedness. ]]>
<![CDATA[]]> /article/doi/10.54531/CTNI2461 Background:Failings in human factors are a significant contributory factor in accidents/incidents in aviation, energy and healthcare. There is no ‘one thing’ that will address human factor failings- it requires multiple interventions; including developing human factor awareness and skills to influence behavioural change. Local research in the Northern Health & Social Care Trust [1] substantiates this. Six months after accessing face-to-face human factor training 70% of attendees confirmed they had made changes to their practice. Through the acquisition of human factor skills staff can ‘get up stream’ of adverse incidents and poorly designed systems, which can reduce patient harm and increase the quality of care.

Aims:

This project deployed the application of Gamification to human factor learning in healthcare. Feedback from face-to-face Human Factor training is positive, but it is challenging in an organization of 13,500 staff to meet the capacity for this training. More recently, response to COVID-19 has challenged us all to think about how we make training more accessible outside of traditional methods.

Method/design:

The Gaming Strategy is centred around Dupont’s Dirty Dozen (Figure 1) – the 12 most common human factor elements which degrade a person’s ability for them to perform effectively and safely, which can lead to errors.
Dupont’s dirty dozen
Figure 1:
Dupont’s dirty dozen
Through a series of missions ‘gamers’ follow a patient (Joe) as he journeys through the healthcare system, and experiences a series of human factor errors. The five missions below, each incorporate Dupont’s Dirty Dozen: communication and team workinglack of knowledge and assertivenesssituational awarenesscomplacency and normspressure and lack of resourcesEach mission introduces characters and is scenario-driven, depending upon gamers’ responses they will either be successful in their mission (in which case they can proceed to the next step), or unsuccessful and have to restart the mission. At the end of each mission ‘gamers’ must complete a quiz, after which they are rewarded with access to the next mission. The gaming App includes additional learning resources, opportunity for reflection and generation of a completion certificate to support professional development. Psychological and behavioural experiences of gamers’ is captured by the App via quizzes at the start and completion of the Game. The project deployed Quality Improvement and Agile development methodologies. All scenarios and characters were developed by the NHSCT project team, with software development commissioned externally.

Implementation outline:

The Game is accessible via mobile phone from the App Store. Project testing completed in June 2021, with the launch of the Game in NHSCT thereafter. The App has potential for scale-up across NI and the UK. ]]>
<![CDATA[]]> /article/doi/10.54531/FXPI7957 Background:Due to the pandemic, our undergraduate programme of Interprofessional (IPE) Full Patient Simulation (FPS) 2020–2021 was converted to a virtual human factors seminar using student case scenario footage and a Non-Technical ABCDE Approach Observational Tool (Seale et al. 2020). The IPE FPS programme involves students (n = 960) from medicine, physiotherapy, nursing (adult, child fields) and midwifery with three strands of scenarios covering acute adult, paediatric and obstetric scenarios. To provide meaningful learning without the use of face-to-face simulation, the principles of active learning and directed observation in simulation were applied to create a live online seminar. Using recorded footage of inter-professional discipline students participating in scenarios and the observational tool provided the resources for students to learn about the non-technical skills (NTS) in clinical practice.

Aim:

The aim of the study was to meet IPE graduate outcomes and to explore the significance of human factors in clinical practice.

Method/design:

Prior to the online seminar, students were allocated into their scenario groups to prepare notes on the non-technical skills, with directive guidance from an observational tool using an ABCDE approach. Within the seminar, students worked collaboratively in small inter-professional groups to discuss their observations and prepare a presentation, guided by the debrief diamond structure of description, analysis and application [1]. Facilitators debriefed after each presentation on the NTS observed [2] to explore why they occurred, and reflect how this impacted on the assessment and management of the patient and what students could apply to their own practice.

Implementation:

Evaluation of findings demonstrated achievement of the key ‘take aways’ associated with live simulation and attainment of learning outcomes (Figure 1). The ABCDE observational tool demonstrated good usability and enabled effective analysis. Students asked that it should be adapted to include the patient in the descriptors and faculty observed students were more critical in their analysis of their peers compared with face-to-face debriefs. The long-term aim is to incorporate virtual seminars into the IPE programme to complement the learning in the face-to-face FPS. Innovations in the FPS programme will include using the scenario footage and the observational tool for pre-simulation briefing material, and the tool for directed observation during live scenarios and additional structure to debriefs. The scenario and debrief footage and the observational tool will also be used for facilitator training.
Figure 1:
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<![CDATA[]]> /article/doi/10.54531/QDPG2486 Background:Due to the sudden shift in online learning at the start of the pandemic, an innovative idea was identified to encourage a student-centred approach for continuing the development of their essential skills whilst learning from home. Taking inspiration from other healthcare programmes, we developed, and risk assessed ‘Skills@Home’ packages to embed a mastery learning approach towards dexterous skills. These comprehensive packages included access to virtual resources and e-learning as well as practical and safety equipment. Implementation of these packages allowed students to maximize their exposure, experience and understanding of a range of skills that could be accessed at a time and pace to suit their needs. The pilot ‘Skills@Home’ package focussed upon the development of suturing, which is a traditional and essential midwifery skill.

Aims:

A collaborative approach between the midwifery team and the clinical simulation and skills education team ensured a robust approach to the risk assessment, procurement and delivery of packages to students’ home addresses. A pre-requisite for receiving a pack was the completion and return of a detailed student agreement form which outlined safety considerations and their responsibilities. The package was piloted with a cohort of 29 third-year student midwives, as a priority group, to facilitate and increase confidence and application in the clinical area and to ensure enough opportunities for progression on the programme.

Method/design:

Students completed an online evaluation form after receiving their packs, which showed overwhelming support for this approach. Students identified that having the opportunity to learn in this manner at home not only enhanced their confidence and skills technique but also helped them to relate theory to practice. Additionally, students identified that they would like to see the ‘Skills@Home’ approach sustained and enhanced once on-campus learning has resumed.

Implementation outline:

This has inspired the clinical simulation and skills education team to identify other Skills@Home packages that can be used within healthcare learning. Ensuring that thorough risk assessments are completed along with the packages being created and delivered to the students in the most cost-effective way. Following the pilot study, ethics approval is currently being sought to explore, using focus groups, the midwifery students’ experiences and view of using the Skills@Home initiative. ]]>
<![CDATA[]]> /article/doi/10.54531/QCYF5806 Background:Within the 6-year Specialist Anaesthesiology Training (SAT) programme overseen by the College of Anaesthesiologists of Ireland (CAI), there is now an option for trainees to take up to 12-month unaccredited professional or personal leave after years 2 and 4. There is also a cohort of trainees taking academic leave, maternity leave or other leave. There is growing recognition in the CAI and among other Training Bodies that returning to work following a period of absence can be daunting. It requires a comprehensive support package to help with the readjustment to the clinical and training environment, and rebuild confidence [1]. The CAI Committee of Anaesthesiology Trainees (CAT) has also made this recommendation after running a voluntary survey among its members.

Aims:

A CAI steering group was convened to design a Return to Programme (RTP) support package, with the following objectives: To develop a strategy for managing a return to anaesthesia following a period of absenceTo provide a blended content learning package aiming to ease SAT back into the clinical environmentTo rebuild confidence with/among the peers in a safe simulation environmentTo improve trainees’ well-being and patient safety by refamiliarization with anaesthesia guidelines and emergency algorithms

Method/design:

It has been agreed that the RTP syllabus must reflect all eight domains of the Irish Medical Council (IMC) domains of Good Professional Practice, as in the following: Patient Safety and Quality of Patient Care; Relating to Patients; Communication and Interpersonal Skills; Collaboration and Teamwork; Management (including Self-Management); Scholarship; Professionalism, and Clinical Skills [2]. This is to be achieved by providing a blended content support package consisting of online refresher lectures in core clinical areas (e.g. perioperative care, paediatric and obstetric anaesthesia, and intensive care medicine), lectures focussed on trainees’ well-being and human resources matters, and face-to-face simulation sessions.

Implementation:

The lectures have been recorded and embedded in the CAI e-learning platform. A list of simulation scenarios reflecting the most common anaesthesiology emergencies has been selected and tailored towards the needs of the destination training sites and experience level. A first course will take place prior to trainees recommencing their clinical role in July 2021. On successful evaluation, it is aimed to conduct the RTP every 6 months going forward. ]]>
<![CDATA[]]> /article/doi/10.54531/WHPG6255 Background:This North London hospital has a 14-bed Intensive Care Unit (ICU). As a small District General ICU, staff exposure to emergency scenarios can be infrequent. Lack of practice can lead to a reduction in staff confidence and knowledge when these scenarios are encountered, especially during the COVID pandemic. The ICU had not previously undertaken in situ multi-disciplinary team (MDT) simulation sessions on the unit.

Aims:

The aim of the study was to introduce a novel programme of MDT simulation sessions in the ICU and provide feedback with the aim of increasing both staff confidence in managing emergency scenarios and staff understanding of the impact of human factors.

Method/design:

A team of ICU Simulation Champions created emergency scenarios that could occur in the ICU. Pre-simulation and post-simulation questionnaires were produced to capture staff opinion on topics including benefits and barriers to simulation training and confidence in managing ICU emergencies. Members of the ICU MDT would be selected to participate in simulation scenarios. Afterwards, debrief sessions would be facilitated by Simulation Champions and Airline Pilots with a particular focus on competence in managing the emergency and human factors elements, such as communication and leadership. Participants would then be surveyed with the post-simulation questionnaire.

Implementation outline:

Nine simulation sessions were conducted between October 2020 and June 2021. The sessions occurred within the ICU during the working day in a designated bay with the availability of all standard ICU resources and involved multiple MDT members to aid fidelity. Feedback by Simulation Champions mainly focussed on knowledge related to the ICU emergency, whilst the Airline Pilots provided expert feedback on human factors training. Fifty-five staff members completed the pre-simulation questionnaire and 37 simulation participants completed the post-simulation questionnaire. Prior to simulation participation, 28.3% of respondents agreed they felt confident managing emergency scenarios on ICU – this figure increased to 54.1% following simulation participation. 94.4% of simulation participants agreed that their knowledge of human factors had improved following the simulation and 100% of participants wanted further simulation teaching. Figure 1 shows a thematic analysis of the responses from 31 participants who were questioned about perceived benefits from simulation teaching. Following the success of the programme, the Hospital Trust will continue to support and develop inter-speciality and inter-professional training, and have funded the appointment of an ICU Simulation Fellow to continue to lead and enhance future in situ simulation teaching on the ICU.
Figure 1:
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<![CDATA[]]> /article/doi/10.54531/JPSD8969 Background:Traditionally, in situ simulation has been used to improve patient care by identifying knowledge or skills gaps and improving teamwork and non-technical skills. However, there are little data demonstrating objective improvement in morbidity and mortality directly attributed to in situ simulation [1]. There is a growing recognition of the use of in situ simulation to detect latent safety errors (LSEs) [1,2]. These are errors of system, environment or teams which may be unrecognized until they are identified in the stressful and realistic conditions of a simulated scenario in a clinical environment. Currently, no standardized system is described to score type or severity of LSE limiting the reproducibility and application of this approach to harm reduction.

Aim:

The aim of the study was to develop a tool to detect latent safety errors during in situ simulation which is fully integrated with existing Trust safety metrics.

Simulation activity outline:

In situ simulation in a district general hospital across community and acute clinical areas.

Method:

Multi-professional in situ simulation was led by an experienced facilitator. A pilot phase was limited to the Acute Medical Unit and informed the thematic classification of errors. Further in situ simulation took place in medical, surgical, emergency department and community hospital settings. Thematic analysis was completed using the framework of Trust incident coding (Radar Healthcare). During the simulation sessions, latent errors were identified and discussed in the debrief. A data collection proforma was developed using an iterative process over 12 months using Microsoft forms. This research was funded by Health Education England South West Simulation Network with the support of the local Somerset Simulation Team.

Results:

During the pilot phase, 73 participants took part in 7 simulations on AMU. Facilitators identified 28 latent errors. Comparison with other sources of safety data (formal incident reporting and critical care outreach team data) showed that in situ simulation identified errors in oxygen and fluid management unrecognized by other data sources. In the second phase, 146 participants took part in 32 in situ simulations. Facilitators identified 82 latent safety errors and coded them into 18 error types (see Table 1). Work is ongoing to compare these to trust incident reports.Table 1:Latent safety error by incident codeThemeNo. of latent errors detectedRadar incident codeTotal by incident codeOxygen use and equipment12Medical devices43Defibrillator use and equipment13Medical devicesFluid delivery and equipment4Medical devicesGlucose monitoring equipment2Medical devicesOther equipment7Medical devicesLocation of equipment5Medical devicesIncorrect medication dose1Medication5Other medication issue4MedicationAccess to a locked area3Health and safety/environment11Emergency call system issue2Health and safety/environmentNoise2Health and safety/environmentOther environment4Health and safety/environmentCardiac arrest algorithm7Care pathway issues17Getting help in an emergency7Care pathway issuesOrganizational3Care pathway issuesCommunication/teamwork2Communication/documentation/IT4E-Obs issue2Communication/documentation/ITAssessment of deteriorating patient2Patient safety2Total82

Implications for practice:

We have identified three major outcomes: Shared learning: latent safety errors are rarely unique to one clinical area and have the potential to occur elsewhere in the Trust. Wider dissemination of latent safety errors at a directorate level allows proactive interventions to reduce patient harm. A monthly Simulation Safety Outcome Report shared with senior nursing staff at a directorate level is being evaluated. Responsive learning and staff engagement: latent safety errors were discussed at every debrief. Participants provided valuable suggestions often resulting in immediate local interventions. This internal resolution has engaged and empowered clinical staff in patient safety. Targeting resources: Integration of active and latent error data from numerous sources allows Trust safety management structures to target resources to improve patient safety and develop sustainable approaches to risk reduction. National standardization of coding active errors (incidents) and latent errors would broaden the use of in situ simulation as a proactive safety tool. ]]>
<![CDATA[]]> /article/doi/10.54531/EKXJ8408 Background:Simulation-based education (SBE) as a learning tool is becoming more prevalent, as is the recognition of the importance of non-technical skills. With this insight comes a desire to improve clinical practice using these techniques. ‘AOSim’ has arisen from an intrinsic desire to achieve this from within an Acute Oncology Service (AOS). Wishes to improve confidence, decision-making and teamwork have guided the design and implementation of a novel simulation course in this field.

Aim:

The purpose of the course has been guided by the candidates. The hope is to be able to provide a safe learning environment to explore decision-making, improve confidence in clinical practice and strengthen teamwork.

Design:

The course design was informed by direct stakeholder analysis. Pre-course surveys aided in planning the course and scenario design. The course would run over half a day and comprise three scenarios, each followed by a debrief. The candidates invited were nurses working in the local AOS and the AOS coordinator. Each scenario was designed with a particular focus in mind; ‘Respectful Challenging’, ‘Clinical Prioritisation’ and ‘Treatment Escalation’. The clinical context of the scenarios was based on oncology to provide a familiar environment for the candidates. This would also enable the focus to be paid to the non-technical skills related to the aims of the course. The scenarios were to be run in a high-fidelity setting using a mixture of role players, mannikins and plants. Faculty roles had been assigned prior to the course date.

Implementation outline:

A course overview was sent to the candidates including the planned date for running the course to allow the candidates to plan for handover of their clinical duties; this allowed protected time for the course to run. ‘AOSim’ was run in a simulation suite in the high-fidelity setting with an experienced faculty. The candidates were introduced to the simulated environment and the importance of psychological safety was explained. The three scenarios ran as planned to include subsequent informative debriefs. Immediate and post-course feedback were positive, particularly with increased confidence levels and team-working ability. This has led to aspirations to run the course again for a different candidate group in the future. ]]>
<![CDATA[]]> /article/doi/10.54531/CKMB2199 Background:The Trust needed to offer extra-corporeal membrane oxygenation (ECMO) [1] patient transport training in the form of high-fidelity multi-disciplinary simulation utilizing a moving ambulance. ECMO circuits and monitoring would be controlled using Chalice’s Parallel Simulator [2]. The simulation would be broadcast to the simulation centre for observation and debrief. We developed a simulation and AV streaming solution for this.

Aim:

The aim of the study was to deliver high-fidelity ECMO simulation in a moving vehicle while simultaneously allowing candidates and faculty to watch the scenarios take place remotely.

Method/design:

A custom video-over-IP system was used to run three camera feeds and a patient monitor output. A laptop captured this in a quad-view format and streamed it to a dedicated video streamer. This was then networked locally via a router with a secondary laptop which displayed the stream. The router was connected to a mobile 4G modem, allowing the secondary laptop to share this video stream via Microsoft Teams (MS Teams). In addition, a USB audio interface and microphones ensured intelligibility while the vehicle was in motion.

Implementation:

Teaching groups were made up of 3–4 candidates from the ECMO team and 3–4 candidates from patient transport. Scenarios outlined a paediatric patient, currently on ECMO, being transferred to a specialist hospital in the region via ambulance. One or two candidates from each service would take part in the scenario and the remaining candidates would view the simulation in the centre debrief room. A technician in front of the ambulance controlled the simulator and monitored the streams. The lead ECMO specialist nurse spoke to the technician from the simulation centre via a mobile phone link. The role of a consultant was played by a member of the transport faculty on the ambulance. This allowed the faculty to oversee and prompt when necessary. Using MS Teams meant the stream could be shared with the debrief room at the centre, the control room, and with other interested parties outside of the centre. This created a unique learning experience where all candidates could see each scenario and play an active role in debrief when the ambulance returned to the centre. Successful delivery of this course will improve patient safety during potentially complex ECMO transfers. We hope to invite more remote participants via MS Teams to view the simulations and take part in the debrief, increasing learning opportunities for ECMO and transfer staff. ]]>
<![CDATA[]]> /article/doi/10.54531/TGCJ1767 Background:William Osler was the first to be credited with taking medical students out of the lecture theatre and to the bedside [1]. However, the COVID-19 pandemic has not just taken medical students out of lectures but also away from the bedside. Virtual reality simulation (VRS) can provide students with a computer-generated environment where users interact with virtual surroundings and patients in any location [2]. To mitigate the gap in clinical experiences we created an education package using VRS for medical students during the initial phases of the pandemic.

Aim:

Could VRS provide a meaningful learning opportunity during the first wave? Could we elicit the strengths and weaknesses of virtual simulation in medical learning?

Method/design:

We used the Oxford Medical Simulation (oxfordmedicalsimulation.com) VRS platform where the learner manages an acutely unwell patient with specified learning objectives (opting for the 2-D to make it accessible to students at home). Scenarios were grouped, accompanied by didactic learning resources and released on a weekly schedule. Data were collected with consent on the number of scenarios accessed, performance score and student feedback.

Implementation outline:

The VRS course ran for 5 weeks (access extended to 11 weeks). In total, 224 students expressed an interest in accessing the VRS platform. Of the 224 students, 64 accessed the scenarios (50% first-year students). The students accessed 821 scenarios. The average score on all first attempts of scenarios was 75%; second attempts 78% and third attempts 90% (Figure 1). Qualitative feedback: ‘I like…the ‘real’ feel of talking to the patient, informing next of kin….it surprised me how real my patient feels’. ‘They are incredibly useful. … I much prefer doing them on a computer screen than in 3D. It does make for a different way of revising’.
Figure 1:
The high initial response rate suggested student interest and engagement. The low (21%) conversion rate to accessing the VRS platform may be explained by initial technical issues and the voluntary nature of the project. The quantitative data show the importance of repetition in improving learning. Participation over time may improve with incorporation into the medical school curriculum. Lower usage among the final-year medical students may be explained by volunteering and early commencement of clinical duties. This innovation reveals some strengths of VRS: basic equipment; learner-directed; improved performance and student interest. Overall, the VRS platform allowed the delivery of a rapid response to fill a gap in clinical education. The next phase of this project will be to provide live tutor-supported debrief. ]]>
<![CDATA[]]> /article/doi/10.54531/VZPO5063 Background:The ‘first wave’ of COVID-19 created many challenges. Our hospital was fortunate to have slightly longer than many others to prepare. One of our Emergency Department (ED) challenges was that, as part of a redesigned process, patients with respiratory failure (presumed COVID-19) were to be assessed in a very different clinical area (single rooms instead of ‘open plan’ resuscitation room), managed by a much larger team of clinicians, using Level 3 (airborne) PPE and a modified approach to Rapid Sequence Intubation (RSI) induction of anaesthesia. Rapid cycle simulation and debrief has subsequently been described as part of a system-based learning approach during the COVID-19 pandemic [1].

Aim:

The aim of this programme was to rapidly familiarize a large team with the new clinical environment and RSI process, using the learning conversation after each simulation to make an immediate change, as required, to the clinical area and/or process.

Method/design:

Each simulation was an identical clinical scenario, i.e. a patient with respiratory distress for whom the need for COVID-19 modified RSI had been identified. The simulation was delivered in the rooms that were subsequently to be used for direct clinical care of confirmed or suspected COVID-19 patients.

Implementation:

A process testing approach was taken. During the simulation brief, the process was talked through in detail (all expected actions and sequence), the team then performed the simulation, followed by a learning conversation that was very focussed on the challenges in delivering this process. Using mobile cameras and large screen TV, all simulations were live streamed to an immediately adjacent area, such that a large number of other clinicians could observe the brief, the simulated clinical scenario and participate in the learning conversation. Agreed changes in equipment, ergonomics and process were immediately incorporated into the next simulation. Once this area was required for direct patient care, an identical room was set up in an adjacent (non-COVID-19 clinical area) to allow daily simulated training to continue. On one occasion, where there was advance notice of the arrival of a patient requiring RSI, the team who were to be involved in the RSI ‘drilled’ this scenario (‘just in time’ simulation) whilst awaiting the arrival of the patient. It was observed that participants who had previously been less comfortable with simulation were happier with this process testing approach (knowing what is expected and with no surprises). ]]>
<![CDATA[]]> /article/doi/10.54531/OTTO2012 Background:Safe training in the current clinical workplace requires careful participant proximity management. Delivering simulation in a confined clinical environment can impact scenario fidelity and affect psychological safety [1]. A portable audio-visual (AV) streaming system enables audiences to observe and contribute to debriefing without compromising simulation fidelity.

Aim:

The aim of the study was to assess the practical efficacy of a portable AV streaming solution to enable real-time in situ simulation, including to a dispersed audience.

Methods/design:

The Scotia Medical Observation and Training System (smots™) offers a portable AV solution with flexibility, through the addition of cameras and microphones as required, to create bespoke simulation viewing. Smots™ was incorporated into the in situ simulation educational programme within an acute trust at least weekly over a 10-month period. It was concurrently deployed at our partner Nightingale facility to run simulation as part of an induction programme for new staff. Feedback from delivery users and scenario participants was collated and analysed.

Implementation outline:

Smots™ was an effective platform to meet our aims. Delivery users reported smots™ to be reliable in streaming the AV footage to a target audience in a remote debriefing room. The system was compact, easily transportable and had a low burden of training to achieve user competence. Participant feedback was positive, in that the system provided good AV clarity and narration, thereby enabling a successful training evolution. Smots™ offers a reliable capability to stream simulation scenarios to an alternative viewing area with the ability to be relocated as needed. Local wireless broadcasting range is finite and may limit users’ ability to stream information to discrete departments within a larger trust. Mitigation is possible using a secondary streaming platform or integrating it into a secure internal Wi-Fi or ethernet network. Assistance from trust information technology departments is recommended and this capability is something our team will consider as a future option. Expanding connectivity is an effect multiplier, offering distanced, streamed training across trusts and regions, as well as the inclusion of participants working from home. The portable nature of this smots™ solution offers flexibility for rapid deployment to areas of novel clinical capability and community partnerships. This system has proved exceptionally useful during a prolonged period of social distancing, enabling ongoing high-efficacy in situ simulation training to a larger target audience within a robust, safe educational environment. ]]>