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Brazil V, Reedy G. Translational simulation revisited: an evolving conceptual model for the contribution of simulation to healthcare quality and safety. Adv Simul (Lond) 2024; 9:16. [PMID: 38720396 PMCID: PMC11080180 DOI: 10.1186/s41077-024-00291-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
The simulation community has effectively responded to calls for a more direct contribution by simulation to healthcare quality and safety, and clearer alignment with health service priorities, but the conceptual framing of this contribution has been vague. The term 'translational simulation' was proposed in 2017 as a "functional term for how simulation may be connected directly with health service priorities and patient outcomes, through interventional and diagnostic functions" (Brazil V. Adv Simul. 2:20, 2017). Six years later, this conceptual framing is clearer. Translational simulation has been applied in diverse contexts, affording insights into its strengths and limitations. Three core concepts are identifiable in recently published translational simulation studies: a clear identification of simulation purpose, an articulation of the simulation process, and an engagement with the conceptual foundations of translational simulation practice. In this article, we reflect on current translational simulation practice and scholarship, especially with respect to these three core concepts, and offer a further elaborated conceptual model based on its use to date.
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Affiliation(s)
- Victoria Brazil
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.
| | - Gabriel Reedy
- Faculty of Life Sciences and Medicine, King's College London, Waterloo Bridge Wing G7, London, UK
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Aljuwaiser S, Abdel-Fattah AR, Brown C, Kane L, Cooper J, Mostafa A. Evaluating the effects of simulation training on stroke thrombolysis: a systematic review and meta-analysis. Adv Simul (Lond) 2024; 9:11. [PMID: 38424568 PMCID: PMC10905914 DOI: 10.1186/s41077-024-00283-6] [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: 11/01/2023] [Accepted: 02/17/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Ischaemic strokes are medical emergencies, and reperfusion treatment, most commonly intravenous thrombolysis, is time-critical. Thrombolysis administration relies on well-organised pathways of care with highly skilled and efficient clinicians. Simulation training is a widespread teaching modality, but results from studies on the impact of this intervention have yet to be synthesised. This systematic review and meta-analysis aimed to synthesise the evidence and provide a recommendation regarding the effects of simulation training for healthcare professionals on door-to-needle time in the emergency thrombolysis of patients with ischaemic stroke. METHODS Seven electronic databases were systematically searched (last updated 12th July 2023) for eligible full-text articles and conference abstracts. Results were screened for relevance by two independent reviewers. The primary outcome was door-to-needle time for recombinant tissue plasminogen activator administration in emergency patients with ischaemic stroke. The secondary outcomes were learner-centred, improvements in knowledge and communication, self-perceived usefulness of training, and feeling 'safe' in thrombolysis-related decision-making. Data were extracted, risk of study bias assessed, and analysis was performed using RevMan™ software (Web version 5.6.0, The Cochrane Collaboration). The quality of the evidence was assessed using the Medical Education Research Study Quality Instrument. RESULTS Eleven studies were included in the meta-analysis and nineteen in the qualitative synthesis (n = 20,189 total patients). There were statistically significant effects of simulation training in reducing door-to-needle time; mean difference of 15 min [95% confidence intervals (CI) 8 to 21 min]; in improving healthcare professionals' acute stroke care knowledge; risk ratio (RR) 0.42 (95% CI 0.30 to 0.60); and in feeling 'safe' in thrombolysis-related decision-making; RR 0.46 (95% CI 0.36 to 0.59). Furthermore, simulation training improved healthcare professionals' communication and was self-perceived as useful training. CONCLUSION This meta-analysis showed that simulation training improves door-to-needle times for the delivery of thrombolysis in ischaemic stroke. However, results should be interpreted with caution due to the heterogeneity of the included studies.
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Affiliation(s)
- Sameera Aljuwaiser
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | | | - Craig Brown
- Emergency Medicine, NHS Grampian, Aberdeen, Scotland
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Leia Kane
- Emergency Medicine, NHS Grampian, Aberdeen, Scotland
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Jamie Cooper
- Emergency Medicine, NHS Grampian, Aberdeen, Scotland
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Alyaa Mostafa
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
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Zucco L, Chen MJ, Levy N, Obeidat SS, Needham MJ, Hyatt A, Keane JR, Pollard RJ, Mitchell JD, Ramachandran SK. Just-in-Time In Situ Simulation Training as a Preparedness Measure for the Perioperative Care of COVID-19 Patients. Simul Healthc 2023; 18:90-99. [PMID: 35148284 PMCID: PMC10081926 DOI: 10.1097/sih.0000000000000635] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Routine workflows were redesigned during the first surge of the COVID-19 pandemic to standardize perioperative management of patients and minimize the risk of viral exposure and transmission to staff members. Just-in-time (JIT), in situ simulation training was adopted to implement urgent change, the value of which in a public health crisis has not previously been explored. METHODS Implementation of workflow changes in the setting of the COVID-19 pandemic was accomplished through JIT, in situ simulation training, delivered over a period of 3 weeks to participants from anesthesia, nursing, and surgery, within our healthcare network. The perceived value of this training method was assessed using a postsimulation training survey, composed of Likert scale assessments and free-text responses. The impact on change in practice was assessed by measuring compliance with new COVID-19 workflows for cases of confirmed or suspected COVID-19 managed in the operating room, between March and August 2020. RESULTS Postsimulation survey responses collected from 110 of 428 participants (25.7%) demonstrated significant positive shifts along the Likert scale on perceived knowledge of new workflow processes, comfort in adopting them in practice and probability that training would have an impact on future practice (all P s < 0.001). Free-text responses reflected appreciation for the training being timely, hands-on, and interprofessional. Compliance with new COVID workflows protocols in practice was 95% (121 of 127 cases) and was associated with lower than expected healthcare worker test positive rates (<1%) within the network during this same period. CONCLUSIONS These findings support JIT, in situ simulation training as a preparedness measure for the perioperative care of COVID-19 patients and demonstrate the value of this approach during public health crises.
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Brazil V, McLean D, Lowe B, Kordich L, Cullen D, De Araujo V, Eldridge T, Purdy E. A relational approach to improving interprofessional teamwork in post-partum haemorrhage (PPH). BMC Health Serv Res 2022; 22:1108. [PMID: 36050714 PMCID: PMC9438096 DOI: 10.1186/s12913-022-08463-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/16/2022] [Indexed: 12/01/2022] Open
Abstract
Background Post-partum haemorrhage (PPH) is an obstetric emergency that requires effective teamwork under complex conditions. We explored healthcare team performance for women who suffered a PPH, focusing on relationships and culture as critical influences on teamwork behaviours and outcomes. Methods In collaboration with clinical teams, we implemented structural, process and relational interventions to improve teamwork in PPH cases. We were guided by the conceptual framework of Relational Coordination and used a mixed methods approach to data collection and analysis. We employed translational simulation as a central, but not singular, technique for enabling exploration and improvement. Key themes were identified from surveys, focus groups, simulation sessions, interviews, and personal communications over a 12-month period. Results Four overarching themes were identified: 1) Teamwork, clear roles and identified leadership are critical. 2) Relational factors powerfully underpin teamwork behaviours—shared goals, shared knowledge, and mutual respect. 3) Conflict and poor relationships can and should be actively explored and addressed to improve performance. 4) Simulation supports improved team performance through multifaceted mechanisms. One year after the project commenced, significant progress had been made in relationships and systems. Clinical outcomes have improved; despite unprecedented increase in labour ward activity, there has not been any increase in large PPHs. Conclusions Teamwork, relationships, and the context of care can be actively shaped in partnership with clinicians to support high performance in maternity care. We present our multifaceted approach as a guide for leaders and clinicians in maternity teams, and as an exemplar for others enacting quality improvement in healthcare.
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Affiliation(s)
| | - Darren McLean
- Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Belinda Lowe
- Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Lada Kordich
- Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Deborah Cullen
- Gold Coast Hospital and Health Service, Gold Coast, Australia
| | | | - Talia Eldridge
- Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Eve Purdy
- Gold Coast Hospital and Health Service, Gold Coast, Australia
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Gent D, Kainth R. Simulation-based procedure training (SBPT) in rarely performed procedures: a blueprint for theory-informed design considerations. Adv Simul (Lond) 2022; 7:13. [PMID: 35527267 PMCID: PMC9079208 DOI: 10.1186/s41077-022-00205-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/06/2022] [Indexed: 11/10/2022] Open
Abstract
Simulation-based procedure training is now integrated within health professions education with literature demonstrating increased performance and translational patient-level outcomes. The focus of published work has been centered around description of such procedural training and the creation of realistic part-task models. There has been little attention with regards to design consideration, specifically around how simulation and educational theory should directly inform programme creation. Using a case-based approach in cardiology as an example, we present a blueprint for theory-informed simulation-based procedure training linking learning needs analysis and defining suitable objectives to matched fidelity. We press the importance of understanding how to implement and utilise task competence benchmarking in practice, and the role of feedback and debriefing in cycles of repeated practice. We conclude with evaluation and argue why this should be considered part of the initial design process rather than an after-thought following education delivery.
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Affiliation(s)
- David Gent
- Faculty of Life Sciences and Medicine, King's College London, London, UK.
- St George's University Hospital NHS Foundation Trust, London, UK.
| | - Ranjev Kainth
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Simulation and Interactive Learning (SaIL) Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Brazil V, Scott C, Matulich J, Shanahan B. Developing a simulation safety policy for translational simulation programs in healthcare. Adv Simul (Lond) 2022; 7:4. [PMID: 35074018 PMCID: PMC8785148 DOI: 10.1186/s41077-022-00200-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/11/2022] [Indexed: 11/19/2022] Open
Abstract
Healthcare simulation may present risks to safety, especially when delivered ‘in situ’—in real clinical environments—when lines between simulated and real practice may be blurred. We felt compelled to develop a simulation safety policy (SSP) after reading reports of adverse events in the healthcare simulation literature, editorials highlighting these safety risks, and reflecting on our own experience as a busy translational simulation service in a large healthcare institution. The process for development of a comprehensive SSP for translational simulation programs is unclear. Personal correspondence with leaders of simulation programs like our own revealed a piecemeal approach in most institutions. In this article, we describe the process we used to develop the simulation safety policy at our health service, and crystalize principles that may provide guidance to simulation programs with similar challenges.
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Juelsgaard J, Løfgren B, Toxvig N, Eriksen GV, Ebdrup L, Jensen RD. Healthcare professionals' experience of using in situ simulation training in preparation for the COVID-19 pandemic: a qualitative focus group study from a Danish hospital. BMJ Open 2022; 12:e056599. [PMID: 34996802 PMCID: PMC8743834 DOI: 10.1136/bmjopen-2021-056599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/20/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic forced hospital organisation and healthcare professionals to prepare for large quantities of patients in isolation rooms. In situ simulation may seem promising in order to manage the organisational changes that the pandemic require. This study aims to investigate in situ simulations influence on healthcare professional's self-perceived preparedness to face the pandemic. DESIGN A qualitative focus group study. SETTING We conducted full scale in situ simulations over a 3-week period in April 2020, including 277 healthcare professionals, at a Danish University Hospital. Subsequently, six semistructured focus group interviews, including 22 participants from the simulations, were conducted in May 2020. PARTICIPANTS 22 healthcare professionals participated in the focus group interviews. METHODS The simulations consisted of a briefing, two scenarios focusing on acute respiratory insufficiency and correct use of personal protective equipment (PPE), and a debriefing. We conducted six focus group interviews using comparable semistructured interview guides focusing on the organisational restructuring of the departments and outcomes of the needs-driven simulation-based programme. We used thematic analysis to identify main themes. RESULTS The informants perceived that the simulations resulted in positive experiences for the healthcare professionals and perceived the organisational changes as effective. They highlighted that simulation enhanced teamwork, demystified the COVID-19 disease, and improved skills, in correct use of PPE and acute treatment of COVID-19 patients. Data revealed that a predefined simulation task force including both experienced simulators and medical experts for facilitation of in situ simulation would be beneficial. CONCLUSION In situ simulation may be useful to enhance learning on organisation and individual level during a pandemic. This educational activity could serve an important role in facilitating hospital preparation and education of large numbers of healthcare professionals during a healthcare crisis. Introduction of a simulation task force is suggested to handle coordination and rapid enrolment across the hospital.
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Affiliation(s)
| | - Bo Løfgren
- Dept of Medicine, Randers Regional Hospital, Randers NE, Denmark
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Neel Toxvig
- Region Midtjylland Koncern HR Udvikling, Aarhus, Denmark
| | | | - Lotte Ebdrup
- Department of Infectious Diseases, Aarhus Universitetshospital, Aarhus, Denmark
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Using Systems Thinking to Identify Staff and Patient Safety Issues in Infectious Disease Simulation Scenarios. Clin Simul Nurs 2021. [DOI: 10.1016/j.ecns.2021.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Blair C, Walsh C, Best P. Immersive 360° videos in health and social care education: a scoping review. BMC MEDICAL EDUCATION 2021; 21:590. [PMID: 34819063 PMCID: PMC8611631 DOI: 10.1186/s12909-021-03013-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/03/2021] [Indexed: 05/23/2023]
Abstract
BACKGROUND Research on the pedagogical use of immersive 360° videos is a rapidly expanding area within health and social care education. Despite this interest, there is a paucity of empirical data on its application. METHOD A scoping review methodology framework was used to search for relevant articles published between 1970 and July 2021. Six databases were used to identify studies using immersive 360° videos for training and education purposes within health and social care: PubMed, Ovid Medline, Psych Info, Psych Articles, Cochrane Database and Embase. Research questions included: Is there any evidence that immersive 360° videos increase learning outcomes and motivation to learn in health and social care education? What are the key pedagogical concepts and theories that inform this area of research? What are the limitations of using immersive 360° videos within health and social education? The four dimensions contained within Keller's ARCS model (attention, relevance, confidence and satisfaction) frame the results section. RESULTS Fourteen studies met our inclusion criteria. Learning outcomes confirm that immersive 360° videos as a pedagogical tool: increases attention, has relevance in skill enhancement, confidence in usability and user satisfaction. In particular, immersive 360° videos has a positive effect on the user's emotional response to the learning climate, which has a significant effect on users' motivation to learn. There was a notable lack of pedagogical theory within the studies retrieved and a general lack of clarity on learning outcomes. CONCLUSION Studies examining the effectiveness of such interventions remains weak due to smaller sample sizes, lack of randomised control trials, and a gap in reporting intervention qualities and outcomes. Nevertheless, 360° immersive video is a viable alternative to VR and regular video, it is cost-effective, and although more robust research is necessary, learning outcomes are promising. FUTURE DIRECTIONS Future research would do well to focus on interactivity and application of pedagogical theory within immersive 360° videos experiences. We argue that more and higher quality research studies, beyond the scope of medical education, are needed to explore the acceptability and effective implementation of this technology.
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Affiliation(s)
- Carolyn Blair
- School of Social Sciences, Education and Social Work, Queen's University Belfast, 6 College Park, Belfast, Northern Ireland.
| | - Colm Walsh
- School of Social Sciences, Education and Social Work, Queen's University Belfast, 6 College Park, Belfast, Northern Ireland
| | - Paul Best
- School of Social Sciences, Education and Social Work, Queen's University Belfast, 6 College Park, Belfast, Northern Ireland
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Kainth R. Dynamic Plus-Delta: an agile debriefing approach centred around variable participant, faculty and contextual factors. Adv Simul (Lond) 2021; 6:35. [PMID: 34620251 PMCID: PMC8496135 DOI: 10.1186/s41077-021-00185-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 09/04/2021] [Indexed: 12/29/2022] Open
Abstract
The current coronavirus pandemic has necessitated rapid intensive care infrastructure expansion with corresponding demand for training healthcare staff. At the NHS Nightingale Hospital, London, the staff underwent a training programme prior to entering the clinical environment with simulation being a core component. This paper describes the rationale for choosing an initial debriefing model which evolved overtime to consider multiple contextual factors: demands of the clinical environment, the diverse participants and their learning needs, the variable experience of faculty, and the dynamic nature of available debriefing time. The new approach, termed here as the Dynamic Plus-Delta model, blends the traditional Plus-Delta approach with specific dynamic elements which considers the unique demands of rapidly training large number of staff. We outline the core features of this model and detail specific considerations around psychological safety. This debriefing approach can be used in similar simulation intervention settings where rapid training of participants is required with multiple and varying contextual factors.
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Affiliation(s)
- Ranjev Kainth
- Faculty of Life Sciences and Medicine, King's College London, London, UK.
- Simulation and Interactive Learning (SaIL) Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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Keyserling K, Janetos E, Sprague C. Teaching Telehealth During a Pandemic and Beyond: an Intern's Survival Guide for Virtual Medicine. J Gen Intern Med 2021; 36:3219-3223. [PMID: 34287776 PMCID: PMC8294316 DOI: 10.1007/s11606-021-07009-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/25/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The rapid transition to telemedicine at the onset of the COVID-19 pandemic required many providers to learn telemedicine "on the fly." As virtual care will likely remain a mainstay of outpatient medicine, it is imperative that telemedicine training be incorporated into graduate medical education. AIM Design a telemedicine curriculum for internal medicine residents based on principles of experiential learning. SETTING VA-based internal medicine primary care clinic. PARTICIPANTS Sixteen first-year internal medicine residents participated in the curriculum. PROGRAM DESCRIPTION The curriculum included a didactic session followed by four simulated patient encounters focused on troubleshooting technical issues, performing the virtual physical exam, coordinating team-based care, and tackling emergencies. PROGRAM EVALUATION Participants reported minimal previous experience with telemedicine. After completing the training, resident confidence in conducting video visits increased from an average score of four to seven (on a 10-point scale). Residents were more likely to agree that video visits would allow them to build bonds and effectively address their patients' needs. This increased confidence persisted at 3 months after training. DISCUSSION Using experiential learning, we identified strategies which increased the confidence of internal medicine trainees in conducting telemedicine visits. Further research is needed to validate our findings across different practice settings.
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Affiliation(s)
- Kaleb Keyserling
- Section of General Medicine, Division of Hospital & Specialty Medicine, Portland VA Medical Center, 3710 SW US Veterans Hospital Rd, Mail code P3MED, Portland, OR, 97239, USA.
| | - Emily Janetos
- Section of General Medicine, Division of Hospital & Specialty Medicine, Portland VA Medical Center, 3710 SW US Veterans Hospital Rd, Mail code P3MED, Portland, OR, 97239, USA
| | - Carol Sprague
- Section of General Medicine, Division of Hospital & Specialty Medicine, Portland VA Medical Center, 3710 SW US Veterans Hospital Rd, Mail code P3MED, Portland, OR, 97239, USA
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Piot MA, Dechartres A, Attoe C, Romeo M, Jollant F, Billon G, Cross S, Lemogne C, Layat Burn C, Michelet D, Guerrier G, Tesniere A, Rethans JJ, Falissard B. Effectiveness of simulation in psychiatry for nursing students, nurses and nurse practitioners: A systematic review and meta-analysis. J Adv Nurs 2021; 78:332-347. [PMID: 34378236 DOI: 10.1111/jan.14986] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/24/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022]
Abstract
AIMS Mental disorders constitute one of the main causes of disease and disability worldwide. While nurses are often at the frontline of mental health care, they have limited access to dedicated psychiatric training opportunities. Simulation training may foster the development of the appropriate competencies required when supporting people with mental disorders. To evaluate the effectiveness of simulation training in psychiatry for nursing students, nurses and nurse practitioners. DESIGN Systematic review and meta-analysis. DATA SOURCES Eight electronic databases, trial registries, key journals and reference lists of selected studies were searched from inception to August 20, 2020 without language restriction. REVIEW METHODS We included randomized and non-randomized controlled studies and single group pre/post studies. Cochrane Risk of Bias tool 2.0 was used for randomized controlled study appraisal, and the Medical Education Research Study Quality instrument was completed for all other studies. Meta-analysis was restricted to randomized controlled studies. The other studies were synthesized narratively. The main outcomes were based on Kirkpatrick levels. RESULTS A total of 118 studies (6738 participants) were found. Interventions included simulated patients (n = 55), role-plays (n = 40), virtual reality (n = 12), manikins (n = 9) and voice simulations (n = 9). Meta-analyses based on 11 randomized controlled studies found a significant large effect size on skills at immediate post-test for simulation compared with active control; and a small and medium effect size on learners' attitudes for simulation compared with inactive control, at immediate post-test and at three-month follow-up respectively. Three quarters of non-randomized controlled studies and pre/post-tests assessing attitudes and skills showed significant differences, and three quarters of participants in randomized controlled studies and pre/post-tests showed significant differences in behaviours. Among the few studies assessing people with mental health outcomes, almost all reported significant differences. CONCLUSION These findings support the effectiveness of simulation training in psychiatric nursing throughout professional development grades, despite heterogeneity in methods and simulation interventions.
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Affiliation(s)
- Marie-Aude Piot
- Université de Paris, Institute Mutualiste Montsouris, Department of Psychiatry, Paris-Saclay University, UVSQ, INSERM 1018, CESP, Ilumens, Simulation Center, Paris, France
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie de l'AP-HP (Cephepi), F75013, Paris, France
| | - Chris Attoe
- Maudsley Simulation, South London & Maudsley NHS Foundation Trust, London, UK
| | - Marie Romeo
- Université de Paris, Institute Mutualiste Montsouris, Department of Psychiatry, Paris-Saclay University, UVSQ, INSERM 1018, CESP, Ilumens, Simulation Center, Paris, France
| | - Fabrice Jollant
- Université de Paris, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Department of Psychiatry, Moods Team, INSERM UMR-1178, CESP, Paris, France.,Nîmes academic hospital (CHU), Nîmes, France.,Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Grégoire Billon
- Maudsley Simulation, South London & Maudsley NHS Foundation Trust, London, UK
| | - Sean Cross
- Maudsley Simulation, South London & Maudsley NHS Foundation Trust, London, UK
| | - Cédric Lemogne
- Université de Paris, AP-HP, Hôpital Hôtel-Dieu, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l'adulte, INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Paris, France
| | - Carine Layat Burn
- Department of Orthopaedic Surgery, La Providence Hospital, Neuchâtel, Switzerland.,Department of Psychotherapy, Berger Psychotherapeutic Centre, Neuchâtel, Switzerland
| | - Daphné Michelet
- Department of Pediatric Anesthesia, CHU of Reims Hôpital Maison Blanche, Reims, France
| | - Gilles Guerrier
- Université de Paris, AP-HP, Cochin Hospital, Anaesthesiology Department, Ilumens, Simulation Center, Paris, France
| | - Antoine Tesniere
- Université de Paris, AP-HP, Cochin Hospital, Anaesthesiology Department, Ilumens, Simulation Center, Paris, France
| | - Jan-Joost Rethans
- Skillslab, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Bruno Falissard
- Public Health Department, School of Medicine, University Paris Saclay, INSERM 1018, CESP, Villejuif, Ile-de-France, France
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Santos TM, Pedrosa RBDS, Carvalho DRDS, Franco MH, Silva JLG, Franci D, de Jorge B, Munhoz D, Calderan T, Grangeia TDAG, Cecilio-Fernandes D. Implementing healthcare professionals' training during COVID-19: a pre and post-test design for simulation training. SAO PAULO MED J 2021; 139:514-519. [PMID: 34378741 PMCID: PMC9632531 DOI: 10.1590/1516-3180.2021.0190.r1.27052021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/27/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Coronavirus disease-19 (COVID-19) has imposed a new reality that presents several challenges for healthcare professionals. The main challenge has been the lack of proper training in relation to an unknown disease. OBJECTIVE To investigate healthcare professionals' acquisition of knowledge of a new airway management protocol for COVID-19 through their participation in simulation training. DESIGN AND SETTING Pre and post-test study with purpose sampling, carried out in a tertiary-level hospital in the city of Campinas, state of São Paulo, Brazil. METHODS This was a cross-sectional pre and post-test intervention among healthcare professionals working in the intensive care unit and emergency department of a large hospital. The training was carried out using an in situ simulation scenario and the participants answered pre and post-tests consisting of a 20-item questionnaire about the new protocol. RESULTS The paired-sample t test demonstrated that there was a significant increase in test score (t = -19.06; P < 0.001), from before the training (M = 8.62; standard deviation, SD = 3.53) to after the simulation training (M = 17.02; SD = 1.76). CONCLUSIONS The simulated training had a positive impact on the healthcare professionals' acquisition of the COVID-19 protocol. We also demonstrated that in situ simulation training was an efficient tool for implementing new protocols, thus bringing benefits to healthcare systems, professionals and patients.
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Affiliation(s)
- Thiago Martins Santos
- MD, PhD. Assistant Professor, Discipline of Emergency Medicine, Department of Internal Medicine, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | | | - Danielle Rachel dos Santos Carvalho
- PhD. Pharmacist and Researcher, Postdoctoral Researcher Program, Department of Medical Psychology and Psychiatry, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Mário Henrique Franco
- MD. Emergency Physician, Discipline of Emergency Medicine, Department of Internal Medicine, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Juliany Lino Gomes Silva
- RN, PhD. Coordinator, Skills Laboratory, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Daniel Franci
- MD. Hospitalist, Discipline of Emergency Medicine, Department of Internal Medicine, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Bruno de Jorge
- BSc. Coordinator, Department of Academic Support, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Daniel Munhoz
- MD, PhD. Cardiologist, Discipline of Cardiology, Department of Internal Medicine, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Thiago Calderan
- MD, MSc. Trauma Surgeon, Discipline of Trauma Surgery, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Tiago de Araujo Guerra Grangeia
- MD, MSc. Pulmonologist, Discipline of Emergency Medicine, Department of Internal Medicine, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Dario Cecilio-Fernandes
- PhD. Researcher, Department of Medical Psychology and Psychiatry, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
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14
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Campbell S, Corbett S, Burlacu CL. Reinstating a national simulation programme in anaesthesiology during the coronavirus pandemic. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:575-580. [PMID: 35520963 PMCID: PMC8245283 DOI: 10.1136/bmjstel-2021-000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 11/03/2022]
Abstract
Background With the introduction of strict public health measures due to the coronavirus pandemic, we have had to change how we deliver simulation training. In order to reinstate the College of Anaesthesiologists Simulation Training (CAST) programme safely, we have had to make significant logistical changes. We discuss the process of reopening a national simulation anaesthesiology programme during a pandemic. Methods We approached how to reinstate the programme with three distinct but intertwined projects, as in the following: (1) a survey of effects of the pandemic on training opportunities for anaesthesiology trainees, (2) proposals for methods of reinstating simulation were developed under the headings avoidance, compromise, accommodation and collaboration. A small online video-assisted simulation pilot was carried out to test the compromise method, (3) having opted for combined accommodation (onsite with smaller participant numbers and safety measures) and collaboration (with other regional centres), a postreinstatement evaluation during a 4-month period was carried out. Results (1) Eighty-five per cent of 64 trainees surveyed felt that they had missed out not only just on simulation-based education (43%) but also on other training opportunities, (2) when five trainees were asked to state on a 1 to 5 Likert scale (strongly disagree, disagree, undecided, agree and strongly agree) whether online video-assisted simulation was similar to face-to-face simulation in four categories (realism, immersion, sense of crisis and stress), only 9 (45%) of the 20 answers agreed they were similar, (3) When onsite simulation was reinstated, the majority of trainees felt that training was similar to prepandemic and were happy to continue with this format. Conclusion In order to reinstate simulation, we have identified that accommodation and collaboration best suited the CAST while compromise failed to rank high among trainees' preferences. Onsite courses will continue to be delivered safely while meeting the high standards our trainees have come to expect.
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Affiliation(s)
- Sinead Campbell
- CAST, College of Anaesthesiologists of Ireland, Dublin, Ireland
- Department of Anaesthesia, Intensive Care and Pain Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - Sarah Corbett
- CAST, College of Anaesthesiologists of Ireland, Dublin, Ireland
- Department of Anaesthesiology, Critical Care and Pain Medicine, St James's Hospital, Dublin, Ireland
| | - Crina L Burlacu
- CAST, College of Anaesthesiologists of Ireland, Dublin, Ireland
- Department of Anaesthesia, Intensive Care and Pain Medicine, St Vincent's University Hospital, Dublin, Ireland
- Division Of Surgery and Surgical Specialties, Dublin, Ireland, University College Dublin—National University of Ireland, Dublin, Ireland
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15
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Brewster DJ, Nickson CP, McGloughlin S, Pilcher D, Sarode VV, Gatward JJ. Preparation for airway management in Australia and New Zealand ICUs during the COVID -19 pandemic. PLoS One 2021; 16:e0251523. [PMID: 33961677 PMCID: PMC8104394 DOI: 10.1371/journal.pone.0251523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/28/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND This paper aimed to describe the airway practices of intensive care units (ICUs) in Australia and New Zealand specific to patients presenting with COVID-19 and to inform whether consistent clinical practice was achieved. Specific clinical airway guidelines were endorsed in March 2020 by the Australian and New Zealand Intensive Care Society (ANZICS) and College of Intensive Care Medicine (CICM). METHODS AND FINDINGS Prospective, structured questionnaire for all ICU directors in Australia and New Zealand was completed by 69 ICU directors after email invitation from ANZICS. The online questionnaire was accessible for three weeks during September 2020 and analysed by cloud-based software. Basic ICU demographics (private or public, metropolitan or rural) and location, purchasing, airway management practices, guideline uptake, checklist and cognitive aid use and staff training relevant to airway management during the COVID-19 pandemic were the main outcome measures. The 69 ICU directors reported significant simulation-based inter-professional airway training of staff (97%), and use of video laryngoscopy (94%), intubation checklists (94%), cognitive aids (83%) and PPE "spotters" (89%) during the airway management of patients with COVID-19. Tracheal intubation was almost always performed by a Specialist (97% of ICUs), who was more likely to be an intensivist than an anaesthetist (61% vs 36%). There was a more frequent adoption of specific airway guidelines for the management of COVID-19 patients in public ICUs (94% vs 71%) and reliance on specialist intensivists to perform intubations in private ICUs (92% vs 53%). CONCLUSION There was a high uptake of a standardised approach to airway management in COVID-19 patients in ICUs in Australia and New Zealand, likely due to endorsement of national guidelines.
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Affiliation(s)
- David J. Brewster
- Intensive Care Unit, Cabrini Hospital, Malvern, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher P. Nickson
- Intensive Care Unit, Alfred Health, Melbourne, Victoria, Australia
- Centre for Health Innovation, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Steve McGloughlin
- Intensive Care Unit, Alfred Health, Melbourne, Victoria, Australia
- The Australian and New Zealand Intensive Care—Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Pilcher
- Centre for Health Innovation, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Vineet V. Sarode
- Intensive Care Unit, Cabrini Hospital, Malvern, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jonathan J. Gatward
- Intensive Care Unit, Royal North Shore, Sydney, NSW, Australia
- The University of Sydney Northern Clinical School, Sydney, NSW, Australia
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16
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Temsah MH, Al Huzaimi A, Alrabiaah A, Alamro N, Al-Sohime F, Al-Eyadhy A, Alhasan K, Kari JA, Alhaboob A, Alsalmi A, AlMuhanna W, Almaghlouth I, Aljamaan F, Halwani R, Saddik B, Barry M, Al-Zamil F, AlHadi AN, Al-Subaie S, Jamal A, Somily AM. Changes in healthcare workers' knowledge, attitudes, practices, and stress during the COVID-19 pandemic. Medicine (Baltimore) 2021; 100:e25825. [PMID: 33950990 PMCID: PMC8104280 DOI: 10.1097/md.0000000000025825] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/11/2021] [Indexed: 01/04/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has caused an unprecedented health crisis around the world, not least because of its heterogeneous clinical presentation and course. The new information on the pandemic emerging daily has made it challenging for healthcare workers (HCWs) to stay current with the latest knowledge, which could influence their attitudes and practices during patient care.This study is a follow-up evaluation of changes in HCWs' knowledge, attitudes, and practices as well as anxiety levels regarding COVID-19 since the beginning of the pandemic. Data were collected through an anonymous, predesigned, self-administered questionnaire that was sent online to HCWs in Saudi Arabia.The questionnaire was sent to 1500 HCWs, with a 63.8% response rate (N = 957). The majority of respondents were female (83%), and the most common age group was 31 to 40 years (52.2%). Nurses constituted 86.3% of the respondents. HCWs reported higher anxiety during the COVID-19 pandemic which increased from 4.91 ± 2.84 to 8.6 ± 2.27 on an 11-point Likert scale compared to other viral outbreaks. HCWs believed that their own preparedness as well as that of their hospital's intensive care unit or emergency room was higher during the COVID-19 pandemic than during the Middle East respiratory syndrome coronavirus pandemic (2012-2015). About 58% of HCWs attended one or more simulations concerning the management of COVID-19 patients in their intensive care unit/emergency room, and nearly all had undergone N95 mask fit testing. The mean score of HCWs' knowledge of COVID-19 was 9.89/12. For most respondents (94.6%), the perception of being at increased risk of infection was the main cause of anxiety related to COVID-19; the mean score of anxiety over COVID-19 increased from 4.91 ± 2.84 before to 8.6 ± 2.27 during the pandemic in Saudi Arabia.HCWs' anxiety levels regarding COVID-19 have increased since a pandemic was declared. It is vital that healthcare facilities provide more emotional and psychological support for all HCWs.
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Affiliation(s)
- Mohamad-Hani Temsah
- College of Medicine, King Saud University
- Department of Pediatrics, King Saud University Medical City
- Prince Abdullah Ben Khaled Coeliac Disease Chair, Faculty of Medicine, King Saud University
| | | | - Abdulkarim Alrabiaah
- College of Medicine, King Saud University
- Department of Pediatrics, King Saud University Medical City
| | - Nurah Alamro
- College of Medicine, King Saud University
- Department of Family and Community Medicine, King Saud University Medical City
- Prince Sattam bin Abdulaziz Research Chair for Epidemiology and Public Health, King Saud University, Riyadh
| | - Fahad Al-Sohime
- College of Medicine, King Saud University
- Department of Pediatrics, King Saud University Medical City
| | - Ayman Al-Eyadhy
- College of Medicine, King Saud University
- Department of Pediatrics, King Saud University Medical City
| | - Khalid Alhasan
- College of Medicine, King Saud University
- Department of Pediatrics, King Saud University Medical City
| | - Jameela A. Kari
- Paediatric Nephrology Centre of excellence, Department of Paediatrics, King Abdulaziz University, Jeddah
| | - Ali Alhaboob
- College of Medicine, King Saud University
- Department of Pediatrics, King Saud University Medical City
| | - Amro Alsalmi
- Department of Pediatrics, King Saud University Medical City
| | | | - Ibrahim Almaghlouth
- College of Medicine, King Saud University
- College of Medicine Research Center, King Saud University
| | - Fadi Aljamaan
- College of Medicine, King Saud University
- Adult Critical Care Department, King Saud University, King Saud University Medical City/King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Rabih Halwani
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Basema Saddik
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Mazin Barry
- College of Medicine, King Saud University
- Infectious Disease Unit, Department of Internal Medicine, King Saud University
| | - Fahad Al-Zamil
- College of Medicine, King Saud University
- Department of Pediatrics, King Saud University Medical City
| | - Ahmad N. AlHadi
- College of Medicine, King Saud University
- Department of Psychiatry, College of Medicine, King Saud University and King Saud University Medical City
- SABIC Psychological Health Research and Applications Chair, College of Medicine
| | - Sarah Al-Subaie
- College of Medicine, King Saud University
- Department of Pediatrics, King Saud University Medical City
| | - Amr Jamal
- College of Medicine, King Saud University
- Department of Family and Community Medicine, King Saud University Medical City
- Evidence-Based Health Care & Knowledge Translation Research Chair, King Saud University
| | - Ali Mohammed Somily
- College of Medicine, King Saud University
- Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia
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17
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Shelton C, Huda T, Lee A. The role of clinical simulation in preparing for a pandemic. BJA Educ 2021; 21:172-179. [PMID: 33520288 PMCID: PMC7836946 DOI: 10.1016/j.bjae.2020.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 01/25/2023] Open
Affiliation(s)
- C. Shelton
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - T. Huda
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - A. Lee
- Columbia University Irving Medical Center, New York, NY, USA
- Margaret Wood Center for Simulation and Education, New York, NY, USA
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18
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Nickson CP, Petrosoniak A, Barwick S, Brazil V. Translational simulation: from description to action. Adv Simul (Lond) 2021; 6:6. [PMID: 33663603 PMCID: PMC7930894 DOI: 10.1186/s41077-021-00160-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/11/2021] [Indexed: 11/10/2022] Open
Abstract
This article describes an operational framework for implementing translational simulation in everyday practice. The framework, based on an input-process-output model, is developed from a critical review of the existing translational simulation literature and the collective experience of the authors' affiliated translational simulation services. The article describes how translational simulation may be used to explore work environments and/or people in them, improve quality through targeted interventions focused on clinical performance/patient outcomes, and be used to design and test planned infrastructure or interventions. Representative case vignettes are used to show how the framework can be applied to real world healthcare problems, including clinical space testing, process development, and culture. Finally, future directions for translational simulation are discussed. As such, the article provides a road map for practitioners who seek to address health service outcomes using translational simulation.
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Affiliation(s)
- Christopher Peter Nickson
- Intensive Care Unit and Centre for Health Innovation, Alfred Health, Melbourne, Australia.
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.
| | - Andrew Petrosoniak
- St. Michael's Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Stephanie Barwick
- Mater Education, South Brisbane, Queensland, Australia
- Bond University, Gold Coast, Australia
| | - Victoria Brazil
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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19
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Lateef F, Suppiah M, Chandra S, Yi TX, Darmawan W, Peckler B, Tucci V, Tirado A, Mendez L, Moreno L, Galwankar S. Simulation Centers and Simulation-Based Education during the Time of COVID 19: A Multi-Center Best Practice Position Paper by the World Academic Council of Emergency Medicine. J Emerg Trauma Shock 2021; 14:3-13. [PMID: 33911429 PMCID: PMC8054807 DOI: 10.4103/jets.jets_185_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/22/2020] [Indexed: 12/23/2022] Open
Abstract
COVID 19 struck us all like a bolt of lightning and for the past 10 months, it has tested our resilience, agility, creativity, and adaptability in all aspects of our lives and work. Simulation centers and simulation-based educational programs have not been spared. Rather than wait for the pandemic to be over before commencing operations and training, we have been actively looking at programs, reviewing alternative methods such as e-learning, use of virtual learning platforms, decentralization of training using in situ simulation (ISS) modeling, partnerships with relevant clinical departments, cross-training of staff to attain useful secondary skills, and many other alternatives and substitutes. It has been an eye-opening journey as we maximize our staff's talent and potential in new adoptions and stretching our goals beyond what we deemed was possible. This paper shares perspectives from simulation centers; The SingHealth Duke NUS Institute of Medical Simulation which is integrated with an Academic Medical Center in Singapore, The Robert and Dorothy Rector Clinical Skills and Simulation Center, which is integrated with Thomas Jefferson University, Oakhill Emergency Department, Florida State University Emergency Medicine Program, Florida, USA and The Wellington Regional Simulation and skills center. It describes the experiences from the time when COVID 19 first struck countries around the world to the current state whereby the simulation centers have stWWarting functioning in their "new norm." These centers were representative examples of those in countries which had extremely heavy (USA), moderate (Singapore) as well as light (New Zealand) load of COVID 19 cases in the nation. Whichever categories these centers were in, they all faced disruption and had to make the necessary adjustments, aligning with national policies and advisories. As there is no existing tried and tested model for the running of a simulation center during an infectious disease pandemic, this can serve as a landmark reference paper, as we continue to fine-tune and prepare for the next new, emerging infectious disease or crisis.
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Affiliation(s)
- Fatimah Lateef
- Senior Consultant, Department of Emergency Medicine, Singapore General Hospital, Professor, Duke NUS Graduate Medical School, Yong Loo Lin School of Medicine, National, University of Singapore and Lee Kong Chian Medical School, Nanyang Technological University, Director, SingHealth Duke NUS Institute of Medical Simulation (SIMS), Philadelphia, USA
| | - Madhavi Suppiah
- Assistant Director, SingHealth Duke NUS Institute of Medical Simulation (SIMS), Philadelphia, USA
| | - Shruti Chandra
- Assistant Professor, Sidney Kimmel Medical College, Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Too Xin Yi
- Assistant Manager, SingHealth Duke NUS Institute of Medical Simulation (SIMS), Wellington, New Zealand
| | - Willy Darmawan
- Senior Executive, SingHealth Duke NUS Institute of Medical Simulation (SIMS), Wellington, New Zealand
| | - Brad Peckler
- Emergency Medicine Specialist and Director of The Wellington Regional Simulation and Skills Center, Capital and Coast District Health Board, Wellington, New Zealand
| | - Veronica Tucci
- Research and Scholarly Activity Director, Oak Hill Emergency Medicine Residency Program, Brooksville, FL USA, Professor of Research and Emergency Medicine, Hattiesburg, MS USA
| | - Alfredo Tirado
- Program Director, Oak Hill Emergency Medicine Residency Program, Brooksville, FL USA
| | - Lorraine Mendez
- Simulation Director, Oak Hill Emergency Medicine Residency Program, Brooksville, FL USA
| | - Lisa Moreno
- President of AAEM, Florida State University Emergency Medicine Residency Program, Associate Professor Florida State University, Sarasota, FL USA
| | - Sagar Galwankar
- Research Director, Florida State University Emergency Medicine Residency Program, Associate Professor Florida State University, Sarasota, FL USA
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20
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Shirani F. Breaking Bad News Training in the Era of COVID-19 Pandemic: The Role of Simulation Based Learning. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2021; 8:2382120521995888. [PMID: 33786379 PMCID: PMC7961702 DOI: 10.1177/2382120521995888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Farzaneh Shirani
- Farzaneh Shirani, Department of Emergency Medicine, Shariati Hospital, Jalal Al-e-Ahmad Highway, Tehran University of Medical Sciences, Tehran 1411713135, Iran.
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21
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Kong JY, Bharadwaj SS, Chinnadurai A, Ho SKY. Being Prepared During the Evolving COVID-19 Pandemic: A Neonatal Experience in Training and Simulation. Front Pediatr 2021; 9:785524. [PMID: 34926355 PMCID: PMC8674782 DOI: 10.3389/fped.2021.785524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Rapid spread of the COVID-19 pandemic raised an urgent need for preparedness in the healthcare sector, including training of healthcare workers to cope with the burden of infected cases while ensuring proper protection of themselves. Improper infection prevention and control measures were key reasons for infection in healthcare workers during the early phase of the outbreak. Objectives/Methods: This paper describes the combined approach of 3 restructured hospitals in Singapore in preparing and training neonatal healthcare workers' during the COVID-19 pandemic crisis, as well as lessons learnt during this process. Results: Information sharing was conducted in the form of e-learning, emphasizing on topics like disease knowledge and infection prevention and control procedures. Skills and competency training were carried out in the form of simulation, with sessions scaled into 4 levels progressing from individual task training to larger group simulations involving multiple disciplines and departments. Challenges encountered included information fatigue by large amount of constantly changing information and multiple amendments to workflows as more information arose. Difficulties conducting training and simulation sessions included restriction of group size to mitigate infection risk amongst participants and the limited supply of personal protective equipment prioritized for direct patient care. Conclusion: Healthcare institutions should ensure adequate dissemination of conceptual knowledge as well as skills competency training of staff in infection control measures for the protection of healthcare workers and patient safety. Ongoing training for sustainability of knowledge and skills, while adapting to the rapidly evolving situation is important in the preparation for future outbreaks.
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Affiliation(s)
- Juin Yee Kong
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Srabani Samanta Bharadwaj
- Duke-NUS Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore, Singapore
| | - Amutha Chinnadurai
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Selina Kah Ying Ho
- Duke-NUS Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore, Singapore
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22
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Gormley GJ, Kajamaa A, Conn RL, O’Hare S. Making the invisible visible: a place for utilizing activity theory within in situ simulation to drive healthcare organizational development? Adv Simul (Lond) 2020; 5:29. [PMID: 33106760 PMCID: PMC7582418 DOI: 10.1186/s41077-020-00148-8] [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: 06/26/2020] [Accepted: 10/09/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The healthcare needs of our societies are continual changing and evolving. In order to meet these needs, healthcare provision has to be dynamic and reactive to provide the highest standards of safe care. Therefore, there is a continual need to generate new evidence and implement it within healthcare contexts. In recent times, in situ simulation has proven to have been an important educational modality to accelerate individuals' and teams' skills and adaptability to deliver care in local contexts. However, due to the increasing complexity of healthcare, including in community settings, an expanded theoretical informed view of in situ simulation is needed as a form of education that can drive organizational as well as individual learning. MAIN BODY Cultural-historical activity theory (CHAT) provides us with analytical tools to recognize and analyse complex health care systems. Making visible the key elements of an in situ simulation process and their interconnections, CHAT facilitates development of a system-level view of needs of change. CONCLUSION In this paper, we theorize how CHAT could help guide in situ simulation processes-to generate greater insights beyond the specific simulation context and bring about meaningful transformation of an organizational activity.
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Affiliation(s)
- Gerard J. Gormley
- Centre for Medical Education, Queen’s University Belfast, Belfast, Northern Ireland
| | - Anu Kajamaa
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
| | - Richard L. Conn
- Centre for Medical Education, Queen’s University Belfast, Belfast, Northern Ireland
| | - Sarah O’Hare
- Centre for Medical Education, Queen’s University Belfast, Belfast, Northern Ireland
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23
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Abstract
INTRODUCTION Working under extreme stress can cause medical professionals to deviate from clinical guidelines even if they know of their existence, let alone in situations such as COVID-19 where guidelines are unclear, fluid, and resources limited. In situ simulation has been proven an effective tool for training medical professionals during previous healthcare crises, eg, Ebola, influenza, as well as for assessing the preparedness of centers by identifying potential latent safety threats. In this article, we describe our ongoing simulation activities to ensure that our staff is best prepared to adapt to the challenges of COVID-19. METHODS This is a prospective preparedness assessment and training intervention at a tertiary care academic center in Lebanon during the COVID-19 pandemic. In situ simulations followed by debriefing with good judgment occur daily involving native teams of 3 to 5 professionals in the newly established COVID intensive care unit and wards, the adult and pediatric intensive care unit and wards, and the emergency department. The simulations are assessed by the instructor using the Simulation Team Assessment Tool and by the participants using the Simulation Effectiveness Tool. Transcripts of recorded simulation debriefings are analyzed for content for latent safety threats using the SHELL Framework (Software-Hardware-Equipment-Liveware). RESULTS In 2 weeks, we conducted 15 simulations with 106 participants and 47 observers. Simulation Team Assessment Tool scores show an overall improvement across the hospital over time [101.5 ± 13 (80-134)]. Participants' feedback on the Simulation Effectiveness Tool has been predominantly positive on the educational and practical benefits of the simulation activity. Data from debriefings and observations demonstrated the following categories of latent safety threats: inadequate preparedness on infection control, uncertainty of guidelines on oxygen supplementation and intubation protocols, lack of leadership and communication, overall panic, and others. CONCLUSIONS Our single-center preparedness intervention demonstrated multiple latent safety threats in relation to COVID-19, which can be recognized through simulation before translating into actual patient care.
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24
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Chan AKM, Rudolph JW, Lau VNM, Wong HMK, Wong RSL, Lo TSF, Choi GYS, Joynt GM. Rapid cycle system improvement for COVID-19 readiness: integrating deliberate practice, psychological safety and vicarious learning. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020. [PMID: 37534688 PMCID: PMC7441440 DOI: 10.1136/bmjstel-2020-000635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction In the face of a rapidly advancing pandemic with uncertain pathophysiology, pop-up healthcare units, ad hoc teams and unpredictable personal protective equipment supply, it is difficult for healthcare institutions and front-line teams to invent and test robust and safe clinical care pathways for patients and clinicians. Conventional simulation-based education was not designed for the time-pressured and emergent needs of readiness in a pandemic. We used ‘rapid cycle system improvement’ to create a psychologically safe learning oasis in the midst of a pandemic. This oasis provided a context to build staff technical and teamwork capacity and improve clinical workflows simultaneously. Methods At the Department of Anaesthesia and Intensive Care in Prince of Wales Hospital, a tertiary institution, in situ simulations were carried out in the operating theatres and intensive care unit (ICU). The translational simulation design leveraged principles of psychological safety, rapid cycle deliberate practice, direct and vicarious learning to ready over 200 staff with 51 sessions and achieve iterative system improvement all within 7 days. Staff evaluations and system improvements were documented postsimulation. Results/Findings Staff in both operating theatres and ICU were significantly more comfortable and confident in managing patients with COVID-19 postsimulation. Teamwork, communication and collective ability to manage infectious cases were enhanced. Key system issues were also identified and improved. Discussion To develop readiness in the rapidly progressing COVID-19 pandemic, we demonstrated that ‘rapid cycle system improvement’ can efficiently help achieve three intertwined goals: (1) ready staff for new clinical processes, (2) build team competence and confidence and (3) improve workflows and procedures.
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Affiliation(s)
- Albert Kam Ming Chan
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, New Territories, Hong Kong
| | - Jenny W Rudolph
- Center for Medical Simulation, Cambridge, Massachusetts, USA
| | - Vivian Nga Man Lau
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, New Territories, Hong Kong
| | - Henry Man Kin Wong
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, New Territories, Hong Kong
| | - Rosinni Si Ling Wong
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, New Territories, Hong Kong
| | - Thomas S F Lo
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Faculty of Medicine, New Territories, Hong Kong
| | - Gordon Y S Choi
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, New Territories, Hong Kong
| | - Gavin Matthew Joynt
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Faculty of Medicine, New Territories, Hong Kong
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Dubé M, Kaba A, Cronin T, Barnes S, Fuselli T, Grant V. COVID-19 pandemic preparation: using simulation for systems-based learning to prepare the largest healthcare workforce and system in Canada. Adv Simul (Lond) 2020; 5:22. [PMID: 32821441 PMCID: PMC7432586 DOI: 10.1186/s41077-020-00138-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/21/2020] [Indexed: 12/12/2022] Open
Abstract
Healthcare resources have been strained to previously unforeseeable limits as a result of the COVID-19 pandemic of 2020. This has prompted the emergence of critical just-in-time COVID-19 education, including rapid simulation preparedness, evaluation and training across all healthcare sectors. Simulation has been proven to be pivotal for both healthcare provider learning and systems integration in the context of testing and integrating new processes, workflows, and rapid changes to practice (e.g., new cognitive aids, checklists, protocols) and changes to the delivery of clinical care. The individual, team, and systems learnings generated from proactive simulation training is occurring at unprecedented volume and speed in our healthcare system. Establishing a clear process to collect and report simulation outcomes has never been more important for staff and patient safety to reduce preventable harm. Our provincial simulation program in the province of Alberta, Canada (population = 4.37 million; geographic area = 661,848 km2), has rapidly responded to this need by leading the intake, design, development, planning, and co-facilitation of over 400 acute care simulations across our province in both urban and rural Emergency Departments, Intensive Care Units, Operating Rooms, Labor and Delivery Units, Urgent Care Centers, Diagnostic Imaging and In-patient Units over a 5-week period to an estimated 30,000 learners of real frontline team members. Unfortunately, the speed at which the COVID-19 pandemic has emerged in Canada may prevent healthcare sectors in both urban and rural settings to have an opportunity for healthcare teams to participate in just-in-time in situ simulation-based learning prior to a potential surge of COVID-19 patients. Our coordinated approach and infrastructure have enabled organizational learnings and the ability to theme and categorize a mass volume of simulation outcome data, primarily from acute care settings to help all sectors further anticipate and plan. The goal of this paper is to share the unique features and advantages of using a centralized provincial simulation response team, preparedness using learning and systems integration methods, and to share the highest risk and highest frequency outcomes from analyzing a mass volume of COVID-19 simulation data across the largest health authority in Canada.
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Affiliation(s)
- Mirette Dubé
- eSIM Provincial Simulation Program, Alberta Health Services, Alberta Health Services, 1403 29th Street NW, Calgary, Alberta T2N 2 T9 Canada
| | - Alyshah Kaba
- eSIM Provincial Simulation Program, Alberta Health Services, Alberta Health Services, 1403 29th Street NW, Calgary, Alberta T2N 2 T9 Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Theresa Cronin
- eSIM Provincial Simulation Program, Alberta Health Services, Alberta Health Services, 1403 29th Street NW, Calgary, Alberta T2N 2 T9 Canada
| | - Sue Barnes
- eSIM Provincial Simulation Program, Alberta Health Services, Alberta Health Services, 1403 29th Street NW, Calgary, Alberta T2N 2 T9 Canada
| | - Tara Fuselli
- eSIM Provincial Simulation Program, Alberta Health Services, Alberta Health Services, 1403 29th Street NW, Calgary, Alberta T2N 2 T9 Canada
| | - Vincent Grant
- eSIM Provincial Simulation Program, Alberta Health Services, Alberta Health Services, 1403 29th Street NW, Calgary, Alberta T2N 2 T9 Canada
- Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- KidSIM Pediatric Simulation Program, Alberta Children’s Hospital, 28 Oki Dr NW, Calgary, Alberta T3B 6A8 Canada
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26
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Lowe B, De Araujo V, Haughton H, Schweitzer J, Brazil V. Preparing maternity for COVID‐19: A translational simulation approach. Aust N Z J Obstet Gynaecol 2020; 60:628-632. [PMID: 32648254 PMCID: PMC7405205 DOI: 10.1111/ajo.13185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022]
Abstract
COVID‐19 has posed major challenges for health care. Hospitals around the world have needed to rapidly prepare for the emerging pandemic. Translational simulation – simulation that is integrated and focused on emerging clinical priorities – offers numerous opportunities to aid in pandemic preparation. We describe our approach to preparing our institution’s maternity services for the COVID‐19 pandemic using translational simulation. We suggest lessons for providers of maternity services, and for those who support them through simulation activities.
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Affiliation(s)
- Belinda Lowe
- Department of Obstetrics and Gynaecology Gold Coast Hospital and Health Service Gold Coast Queensland Australia
- Faculty of Health Sciences and Medicine Bond University Gold Coast Queensland Australia
| | - Victoria De Araujo
- Department of Obstetrics and Gynaecology Gold Coast Hospital and Health Service Gold Coast Queensland Australia
| | - Helen Haughton
- Department of Obstetrics and Gynaecology Gold Coast Hospital and Health Service Gold Coast Queensland Australia
- Faculty of Health Sciences and Medicine Bond University Gold Coast Queensland Australia
| | - Jane Schweitzer
- Simulation Service Gold Coast Hospital and Health Service Gold Coast Queensland Australia
| | - Victoria Brazil
- Faculty of Health Sciences and Medicine Bond University Gold Coast Queensland Australia
- Department of Emergency Medicine and Simulation Service Gold Coast Hospital and Health Service Gold Coast Queensland Australia
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27
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Lakissian Z, Sabouneh R, Zeineddine R, Fayad J, Banat R, Sharara-Chami R. In-situ simulations for COVID-19: a safety II approach towards resilient performance. Adv Simul (Lond) 2020; 5:15. [PMID: 32754345 PMCID: PMC7388429 DOI: 10.1186/s41077-020-00137-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/21/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND COVID-19 has taken the world by surprise; even the most sophisticated healthcare systems have been unable to cope with the volume of patients and lack of resources. Yet the gradual spread of the virus in Lebanon has allowed healthcare facilities critical time to prepare. Simulation is the most practical avenue not only for preparing the staff but also for troubleshooting system's latent safety threats (LSTs) and for understanding these challenges via Hollnagel's safety I-II approaches. METHODS This is a quality improvement initiative: daily in situ simulations were conducted across various departments at the American University of Beirut Medical Center (AUBMC), a tertiary medical care center in Beirut, Lebanon. These simulations took place in the hospital with native multidisciplinary teams of 3-5 members followed by debriefing with good judgment using the modified PEARLS (Promoting Excellence and Reflective Learning in Simulation) for systems integration. All participants completed the simulation effectiveness tool (SET-M) to assess the simulation. Debriefings were analyzed qualitatively for content based on the Safety Model and LST identification, and the SET-Ms were analyzed quantitatively. RESULTS Twenty-two simulations have been conducted with 131 participants. SET-M results showed that the majority (78-87%) strongly agreed to the effectiveness of the intervention. We were able to glean several clinical and human factor safety I-II components and LSTs such as overall lack of preparedness and awareness of donning/doffing of personal protective equipment (PPE), delayed response time, lack of experience in rapid sequence intubation, inability to timely and effectively assign roles, and lack of situational awareness. On the other hand, teams quickly recognized the patient's clinical status and often communicated effectively. CONCLUSION This intervention allowed us to detect previously unrecognized LSTs, prepare our personnel, and offer crucial practical hands-on experience for an unprecedented healthcare crisis.
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Affiliation(s)
- Zavi Lakissian
- Dar Al-Wafaa Simulation in Medicine (DAWSIM), American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Sabouneh
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, P.O. Box 11-0236 Riad El Solh, Beirut, 110 72020 Lebanon
| | - Rida Zeineddine
- Dar Al-Wafaa Simulation in Medicine (DAWSIM), American University of Beirut Medical Center, Beirut, Lebanon
| | - Joe Fayad
- Department of Fine Arts, American University of Beirut, Beirut, Lebanon
| | - Rim Banat
- Dar Al-Wafaa Simulation in Medicine (DAWSIM), American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana Sharara-Chami
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, P.O. Box 11-0236 Riad El Solh, Beirut, 110 72020 Lebanon
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