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Lu A, Pian-Smith MCM, Burden A, Fernandez GL, Fortner SA, Rege RV, Slakey DP, Velasco JM, Cooper JB, Steadman RH. Call to Action: Quality and Simulation Professionals Should Collaborate. Simul Healthc 2024; 19:319-325. [PMID: 39362653 DOI: 10.1097/sih.0000000000000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2024]
Abstract
SUMMARY STATEMENT Simulation is underutilized as a tool to improve healthcare quality and safety despite many examples of its effectiveness to identify and remedy quality and safety problems, improve teamwork, and improve various measures of quality and safety that are important to healthcare organizations, eg, patient safety indicators. We urge quality and safety and simulation professionals to collaborate with their counterparts in their organizations to employ simulation in ways that improve the quality and safety of care of their patients. These collaborations could begin through initiating conversations among the quality and safety and simulation professionals, perhaps using this article as a prompt for discussion, identifying one area in need of quality and safety improvement for which simulation can be helpful, and beginning that work.
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Affiliation(s)
- Amy Lu
- From the UCSF Health and Anesthesia and Perioperative Care (A.L.), UCSF School of Medicine, San Francisco, CA; Enterprise Anesthesiology Quality and Safety, Mass General Brigham (M.C.M.P.-S.), Harvard Medical School, Massachusetts General Hospital, Boston, MA; Clinical Skills and Simulation Education (A.B.), Cooper Medical School of Rowan University and Cooper University Healthcare, Camden, NJ; Surgery UMMS-Chan-Baystate (G.L.F.), Baystate Health, Springfield, MA; Anesthesiology and Critical Care Medicine (S.A.F.), University of New Mexico School of Medicine, Albuquerque, NM; Surgery, Undergraduate Medical Education (R.V.R.), University of Texas Southwestern Medical Center, Dallas, TX; Department of Surgery (D.P.S.), University of Illinois at Chicago, Chicago, IL; Surgery, Surgical Innovation (J.M.V.), Rush University, Chicago, IL; Department of Anesthesia, Critical Care and Pain Medicine (J.B.C.), Harvard Medical School and Massachusetts General Hospital, Boston, MA; and Department of Anesthesiology and Critical Care (R.H.S.), Houston Methodist Hospital, Houston, TX
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Grace MA, O'Malley R. Using In Situ Simulation to Identify Latent Safety Threats in Emergency Medicine: A Systematic Review. Simul Healthc 2024; 19:243-253. [PMID: 37725494 DOI: 10.1097/sih.0000000000000748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
SUMMARY STATEMENT This review aimed to explore existing literature on the use of in situ simulation to identify latent safety threats in emergency medicine. Studies were required to take place in a clinically active emergency department and have either a primary or secondary aim of identifying latent safety threats. A total of 2921 articles were retrieved through database searches and a total of 15 were deemed to meet the inclusion criteria.Latent safety threats were detected by a variety of methods including documentation during debrief/discussion (66%), during the simulation itself (33%), participant surveys (20%), and video analysis (20%). Using a multimodality approach with input from observers and participants from different professional backgrounds yielded the highest number of threats per simulation case (43 per case). Equipment was the most commonly reported threat (83%), followed by teamwork/communication (67%). Some studies did not report on mitigation of identified risks; formal processes should be implemented for the management of latent safety threats identified by in situ simulation. Future research should focus on translational outcomes to further strengthen the position of in situ simulation in emergency medicine.
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Affiliation(s)
- Margaret A Grace
- From the Mater Misericordiae University Hospital, Dublin (M.G.); and National University of Ireland, Galway, Ireland (R.O.M.)
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Große Lordemann A, Sommerfeldt D, Mileder L. [Latent safety threats in a pediatric emergency department: Using in situ simulation to test a new trauma room concept]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2024; 187:15-21. [PMID: 38644149 DOI: 10.1016/j.zefq.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/07/2024] [Accepted: 03/19/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION Structured emergency room concepts have been shown to contribute to patient safety. Until now there has been no uniform emergency room concept for critically ill and seriously injured children and adolescents in the emergency room at the Altona Children's Hospital in Hamburg. This concept has been newly developed in interdisciplinary cooperation and includes the use of new clinical premises as well as new responsibilities and team compositions. The introduction of new processes and rooms for handling emergencies is associated with a risk of overlooking latent safety deficiencies or detecting them only after the process has been implemented. This may have a direct impact on patient safety. Before moving to new clinical premises, in situ simulation can be helpful to identify and to resolve latent safety threats in advance. Therefore, this method was chosen to test the newly created emergency room concept in the future emergency room at the Altona Children's Hospital. METHODS Two in situ simulations were carried out in the future real emergency room. Latent safety threats detected by the observation team and the participants (medical and nursing staff of the Altona Children's Hospital from the departments of pediatric surgery, traumatology, orthopedics, pediatrics, anesthesia, intensive care medicine, radiology, emergency medicine) were collected using free text notes after the simulations and evaluated retrospectively. In order to better deal with these latent safety threats, the observations were classified into different categories: working environment (e.g., lack of equipment, unfavorable positioning of material), process (e.g., lack of defined responsibilities in the team) and other safety threats that did not fall into one of the two categories defined. RESULTS A total of 51 latent safety threats were identified during the two in situ simulations. Of these, 22 (43.1%) were assigned to the "working environment" category, 20 (39.2%) to the "process" category and 9 (17.7%) to the "other safety threats" category. Of the latent safety threats identified, 46 (90.2 %) could be resolved before the emergency room was put into operation. For the non-recoverable safety threats, safety concepts were developed in order to further minimize the risk of patient hazard. DISCUSSION With the help of this study, it could be shown that the implementation of in situ simulation before the commissioning of new clinical premises and the introduction of new processes can contribute to the detection of latent safety threats in an interdisciplinary German pediatric emergency department.
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Affiliation(s)
- Anja Große Lordemann
- Altonaer Kinderkrankenhaus gGmbH, Hamburg, Deutschland; Netzwerk Kindersimulation e.V, Tübingen, Deutschland.
| | | | - Lukas Mileder
- Netzwerk Kindersimulation e.V, Tübingen, Deutschland; Stabsstelle Clinical Skills Center, Medizinische Universität Graz, Graz, Österreich; Klinische Abteilung für Neonatologie, Univ.-Klinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich
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Kennedy C, Sycip M, Woods S, Ell L. A Novel Approach to Emergency Department Readiness for Airborne Precautions Using Simulation-Based Clinical Systems Testing. Ann Emerg Med 2023; 81:126-139. [PMID: 36257865 PMCID: PMC9568412 DOI: 10.1016/j.annemergmed.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVES Emergency department (ED) COVID-19 preparations required rethinking workflows and introducing the potential for errors. Simulation provides a nimble methodology integrating into situ training and systems testing to prepare staff, detect potential workflow latent safety threats and provide recommendations for mitigation. METHODS We developed 5 onsite rapid-cycle ED simulation cases using "tipping points" related to new protocols coupled with a structured observation tool. Staff observed simulations, recorded adherence to protocols, identified safety threats, discussed mitigation strategies, and participants completed an evaluation using a 5-point Likert scale. Latent safety threats were prioritized by risk and escalated to leadership. RESULTS Through 44 simulations, 76 staff identified 31 unique latent safety threats in the following categories: job aids 9 (29%), isolation measures 8 (26%), communication and personnel 6 (19%), and technology and equipment 8 (26%). Eleven high-priority safety threats were escalated to ED leadership. Sixty-five staff (86% of participants) completed a web-based evaluation reporting that simulations were worth the time (86% strongly agreed), an effective way to test the system (92% strongly agreed), and an acceptable way to improve (92% strongly agreed). CONCLUSION Our study demonstrated that simulation-based clinical systems test methods are adaptable for rapid preparedness evaluation and training. In combination with rapid-cycle deliberate practice, many latent safety threats were identified prior to clinical implementation. Our work highlights a novel application of simulation systems to increase system preparedness and reduce the potential for errors which may be applicable in diverse settings for designing, evaluating, and training staff in new protocols and procedures.
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Affiliation(s)
- Christopher Kennedy
- Division of Emergency Medicine, Center for Pediatric Simulation and Resuscitation, Children’s Mercy Hospital Kansas City, Kansas City, MO,Corresponding Author
| | - Marc Sycip
- Division of Emergency Medicine, Center for Pediatric Simulation and Resuscitation, Children’s Mercy Hospital Kansas City, Kansas City, MO
| | - Shautonja Woods
- Department of Quality and Safety, Center for Pediatric Simulation and Resuscitation, Children’s Mercy Hospital Kansas City, Kansas City, MO
| | - Lisa Ell
- Department of Quality and Safety, Center for Pediatric Simulation and Resuscitation, Children’s Mercy Hospital Kansas City, Kansas City, MO
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Mastoras G, Farooki N, Willinsky J, Dharamsi A, Somers A, Gray A, Yaphe J, Dalseg T, O'Connor E. Rapid deployment of a virtual simulation curriculum to prepare for critical care triage during the COVID-19 pandemic. CAN J EMERG MED 2022; 24:382-389. [PMID: 35338451 PMCID: PMC8956452 DOI: 10.1007/s43678-022-00280-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/04/2022] [Indexed: 01/22/2023]
Abstract
Background During the COVID-19 pandemic in Ontario, Canada, an EmergencyStandardofCare forMajorSurge was created to establish a uniform process for the “triage” of finite critical care resources. This proposed departure from usual clinical care highlighted the need for an educational tool to prepare physicians for making and communicating difficult triage decisions. We created a just-in-time, virtual, simulation-based curriculum and evaluated its impact for our group of academic Emergency Physicians. Methods Our curriculum was developed and evaluated following Stufflebeam’s Context-Input-Process–Product model. Our virtual simulation sessions, delivered online using Microsoft Teams, addressed a range of clinical scenarios involving decisions about critical care prioritization (i.e., Triage). Simulation participants completed a pre-course multiple-choice knowledge test and rating scales pertaining to their attitudes about using the Emergency Standard of Care protocol before and 2–4 weeks after participating. Qualitative feedback about the curriculum was solicited through surveys. Results Nine virtual simulation sessions were delivered over 3 weeks, reaching a total of 47 attending emergency physicians (74% of our active department members). Overall, our intervention led to a 36% (95% CI 22.9–48.3%) improvement in participants’ self-rated comfort and attitudes in navigating triage decisions and communicating with patients at the end of life. Scores on the knowledge test improved by 13% (95% CI 0.4–25.6%). 95% of participants provided highly favorable ratings of the course content and similarly indicated that the session was likely or very likely to change their practice. The curriculum has since been adopted at multiple sites around the province. Conclusion Our novel virtual simulation curriculum facilitated rapid dissemination of the Emergency Standard of Care for Major Surge to our group of Emergency Physicians despite COVID-19-related constraints on gathering. The active learning afforded by this method improved physician confidence and knowledge with these difficult protocols. Supplementary Information The online version contains supplementary material available at 10.1007/s43678-022-00280-6.
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Affiliation(s)
- George Mastoras
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada. .,Department of Emergency Medicine, University Health Network, Toronto, ON, Canada. .,R Fraser Elliott Building, 200 Elizabeth StGround Floor Room 480, Toronto, ON, M5G2C4, Canada.
| | - Nadia Farooki
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Emergency Medicine, University Health Network, Toronto, ON, Canada
| | - Jacqueline Willinsky
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Emergency Medicine, University Health Network, Toronto, ON, Canada
| | - Alia Dharamsi
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Emergency Medicine, University Health Network, Toronto, ON, Canada
| | - Andrea Somers
- Department of Emergency Medicine, University Health Network, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Alice Gray
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Emergency Medicine, University Health Network, Toronto, ON, Canada
| | - Joel Yaphe
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Emergency Medicine, University Health Network, Toronto, ON, Canada
| | - Timothy Dalseg
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Emergency Medicine, University Health Network, Toronto, ON, Canada.,Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Erin O'Connor
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Emergency Medicine, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Rojo E, Maestre JM, Piedra L, Esteban J, Sánchez B, Hoz V, Del Moral I. [Interprofessional team training with in situ simulation to improve the quality of cardiopulmonary resuscitation]. J Healthc Qual Res 2021; 37:92-99. [PMID: 34824042 DOI: 10.1016/j.jhqr.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/19/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In situ simulation facilitates training in clinical settings under similar emotional pressure that occurs in real life situations. The objective of the present study was to assess the feasibility, implementation, facilitators self-confidence and teaching challenges of a training program of cardiopulmonary resuscitation through an in situ simulation plan. METHOD A training program was designed for the facilitators. The number of professionals trained and in situ simulations performed were recorded, as well as the logistical challenges. An ad hoc survey was designed to assess facilitators self-confidence and educational challenge which were classified using the debriefing assessment for simulation in healthcare©. RESULTS During a period of 3 years, 95 trained facilitators implemented 378 in situ simulations that allowed to train 1281 nursing professionals working at inpatient units. Integration of in situ simulations with daily activities and availability of facilitators were the main logistical challenges. Stablishing and maintaining a stimulating learning environment and structuring the debriefing in an organized way were the main educational challenges. CONCLUSIONS In situ simulation helps to train the coordination of nursing teams taking care of patients in cardiorespiratory arrest and to identify the risks that may affect patient safety. Identifying the educational challenges during the implementation of in situ simulation facilitates the design of specific educational and monitoring strategies.
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Affiliation(s)
- Elena Rojo
- Hospital virtual Valdecilla, Santander, España; Hospital Universitario Valdecilla, Santander, España.
| | - Jose M Maestre
- Hospital virtual Valdecilla, Santander, España; Hospital Universitario Valdecilla, Santander, España
| | - Liébana Piedra
- Hospital virtual Valdecilla, Santander, España; Hospital Sierrallana/Tres Mares, Torrelavega, España
| | | | - Beatriz Sánchez
- Hospital virtual Valdecilla, Santander, España; Hospital de Laredo, Laredo, España
| | - Verónica Hoz
- Hospital virtual Valdecilla, Santander, España; Hospital Sierrallana/Tres Mares, Torrelavega, España
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Mastoras GN, Cheung WJ, Krywenky A, Addleman S, Weitzman B, Frank JR. Faculty Sim: Implementation of an Innovative, Simulation-based Continuing Professional Development Curriculum for Academic Emergency Physicians. AEM EDUCATION AND TRAINING 2021; 5:e10559. [PMID: 34124507 PMCID: PMC8171772 DOI: 10.1002/aet2.10559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Maintaining and enhancing competence in the breadth of emergency medicine (EM) is an ongoing challenge. In particular, resuscitative care in EM involves high-risk clinical encounters that demand strong procedural skills, effective team leadership, and up-to-date clinical knowledge. Simulation-based medical education is an effective modality for enhancing technical and nontechnical skills in crisis situations and has been effectively embedded in undergraduate and postgraduate medical curricula worldwide. To our knowledge, there are few existing systematic department-wide simulation programs to address continuing professional development (CPD) for practicing academic EM faculty. DEVELOPMENT PROCESS We developed our novel, simulation-based CPD program following Kern's six-step model. Based on the results of a multimodal needs assessment, a longitudinal curriculum was mapped and tailored to the available resources. Institutional support was provided in the form of a departmental grant to fund a physician program lead, monthly session instructors, and operating costs. OUTCOMES CPD simulation sessions commenced in January 2017. Our needs assessment identified two key types of educational needs: 1) crisis resource management skills and 2) frequent practice of high-stakes critical care procedures (e.g., surgical airways). Simulation sessions involve two high-fidelity simulated resuscitations and one skills lab per day. To date, 21 sessions have been delivered, reaching 161 practicing EPs. Feedback from our faculty has been positive. REFLECTIVE DISCUSSION We have successfully introduced a curriculum of monthly simulation-based CPD based on the educational needs of our EPs. Future work will include more detailed program evaluation linked to clinical outcomes and program expansion to support nearby institutions.
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Affiliation(s)
- George N. Mastoras
- From theDepartment of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Warren J. Cheung
- From theDepartment of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntarioCanada
- and theRoyal College of Physicians and Surgeons of CanadaOttawaOntarioCanada
| | - Ashley Krywenky
- From theDepartment of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Sarah Addleman
- From theDepartment of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Brian Weitzman
- From theDepartment of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Jason R. Frank
- From theDepartment of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntarioCanada
- and theRoyal College of Physicians and Surgeons of CanadaOttawaOntarioCanada
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Ayache S, Schmerber S. Covid-19 and Otologic/Neurotologic Practices: Suggestions to Improve the Safety of Surgery and Consultations. Otol Neurotol 2020; 41:1175-1181. [PMID: 32925833 DOI: 10.1097/mao.0000000000002851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
: Since the beginning of 2020, the world has been confronted by the Covid-19 pandemic. The lock-down aims to limit the circulation of the virus and thus avoid overwhelming healthcare systems. Healthcare workers have had to adapt by postponing consultation and surgical activities. Otolaryngologists are particularly exposed to infection from the upper airway where the virus is highly concentrated. Literature has previously reported other human coronaviruses in the middle ear and mastoid, suggesting a risk of infection to staff during ear surgery where aerosolizing procedures are usually used. The aim of this article is to propose a strategy for planning consultations and surgeries for ear and lateral skull base diseases, in the context of the current active evolution of the pandemic and of the future gradual recovery to normal practice.
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Affiliation(s)
- Stephane Ayache
- Department of Otorhinolaryngology - Head and Neck Surgery, Otology and Neurotology Unit, Hospital Centre Simone Veil, Cannes
| | - Sebastien Schmerber
- Department of Otorhinolaryngology - Head and Neck Surgery, Otology and Neurotology Unit, University Hospital Center - Grenoble, France
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Al Juhani T, Al Zughaibi N, Haroun A, Al Saad A. Perioperative care of pediatric anesthesia for children with suspected or confirmed COVID-19. Saudi J Anaesth 2020; 14:370-377. [PMID: 32934632 PMCID: PMC7457999 DOI: 10.4103/sja.sja_358_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/11/2020] [Accepted: 04/27/2020] [Indexed: 12/14/2022] Open
Abstract
COVID-19 is a pandemic disease that recently been spreading all over the globe. Health-care bodies recognize that organized and written protocols are essential tools to help in fighting this highly contagious virus. In this review, we published our protocol and recommendations in the pediatric anesthesia department in our hospital in preparation for the management of children who are confirmed or suspected in perioperative periods.
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Affiliation(s)
- Talal Al Juhani
- Department of Pediatric Anesthesia, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Nezar Al Zughaibi
- Department of Pediatric Anesthesia, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ahmad Haroun
- Department of Pediatric Anesthesia, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed Al Saad
- Department of Pediatric Anesthesia, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
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Wong J, Goh QY, Tan Z, Lie SA, Tay YC, Ng SY, Soh CR. Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore. Can J Anaesth 2020; 67:732-745. [PMID: 32162212 PMCID: PMC7090449 DOI: 10.1007/s12630-020-01620-9] [Citation(s) in RCA: 400] [Impact Index Per Article: 100.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 02/07/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) outbreak has been designated a public health emergency of international concern. To prepare for a pandemic, hospitals need a strategy to manage their space, staff, and supplies so that optimum care is provided to patients. In addition, infection prevention measures need to be implemented to reduce in-hospital transmission. In the operating room, these preparations involve multiple stakeholders and can present a significant challenge. Here, we describe the outbreak response measures of the anesthetic department staffing the largest (1,700-bed) academic tertiary level acute care hospital in Singapore (Singapore General Hospital) and a smaller regional hospital (Sengkang General Hospital). These include engineering controls such as identification and preparation of an isolation operating room, administrative measures such as modification of workflow and processes, introduction of personal protective equipment for staff, and formulation of clinical guidelines for anesthetic management. Simulation was valuable in evaluating the feasibility of new operating room set-ups or workflow. We also discuss how the hierarchy of controls can be used as a framework to plan the necessary measures during each phase of a pandemic, and review the evidence for the measures taken. These containment measures are necessary to optimize the quality of care provided to COVID-19 patients and to reduce the risk of viral transmission to other patients or healthcare workers.
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Affiliation(s)
- Jolin Wong
- Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
| | - Qing Yuan Goh
- Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Zihui Tan
- Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Sui An Lie
- Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Yoong Chuan Tay
- Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Shin Yi Ng
- Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Chai Rick Soh
- Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
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