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Diaz-Navarro C, Armstrong R, Charnetski M, Freeman KJ, Koh S, Reedy G, Smitten J, Ingrassia PL, Matos FM, Issenberg B. Global consensus statement on simulation-based practice in healthcare. Adv Simul (Lond) 2024; 9:19. [PMID: 38769577 PMCID: PMC11106913 DOI: 10.1186/s41077-024-00288-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/22/2024] Open
Abstract
Simulation plays a pivotal role in addressing universal healthcare challenges, reducing education inequities, and improving mortality, morbidity and patient experiences. It enhances healthcare processes and systems, contributing significantly to the development of a safety culture within organizations. It has proven to be cost-effective and successful in enhancing team performance, fostering workforce resilience and improving patient outcomes.Through an international collaborative effort, an iterative consultation process was conducted with 50 societies operating across 67 countries within six continents. This process revealed common healthcare challenges and simulation practices worldwide. The intended audience for this statement includes policymakers, healthcare organization leaders, health education institutions, and simulation practitioners. It aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally.Key recommendations Advocating for the benefits that simulation provides to patients, staff and organizations is crucial, as well as promoting its adoption and integration into daily learning and practice throughout the healthcare spectrum. Low-cost, high-impact simulation methods should be leveraged to expand global accessibility and integrate into system improvement processes as well as undergraduate and postgraduate curricula. Support at institutional and governmental level is essential, necessitating a unified and concerted approach in terms of political, strategic and financial commitment.It is imperative that simulation is used appropriately, employing evidence-based quality assurance approaches that adhere to recognized standards of best practice. These standards include faculty development, evaluation, accrediting, credentialing, and certification.We must endeavor to provide equitable and sustainable access to high-quality, contextually relevant simulation-based learning opportunities, firmly upholding the principles of equity, diversity and inclusion. This should be complemented with a renewed emphasis on research and scholarship in this field.Call for action We urge policymakers and leaders to formally acknowledge and embrace the benefits of simulation in healthcare practice and education. This includes a commitment to sustained support and a mandate for the application of simulation within education, training, and clinical environments.We advocate for healthcare systems and education institutions to commit themselves to the goal of high-quality healthcare and improved patient outcomes. This commitment should encompass the promotion and resource support of simulation-based learning opportunities for individuals and interprofessional teams throughout all stages and levels of a caregiver's career, in alignment with best practice standards.We call upon simulation practitioners to champion healthcare simulation as an indispensable learning tool, adhere to best practice standards, maintain a commitment to lifelong learning, and persist in their fervent advocacy for patient safety.This statement, the result of an international collaborative effort, aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally.
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Affiliation(s)
| | - Robert Armstrong
- School of Health Professions, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Matthew Charnetski
- Simulation-Based Education and Research, Dartmouth Health, Lebanon, NH, USA
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | - Kirsty J Freeman
- The Rural Clinical School of Western Australia, The University of Western Australia, Perth, Australia
| | - Sabrina Koh
- SingHealth Duke-NUS Institute of Medical Simulation, SingHealth Academy, Singapore, Singapore
- Nursing Education and Development, Sengkang General Hospital, Singapore, Singapore
| | - Gabriel Reedy
- Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | - Jayne Smitten
- School of Nursing, Hawai'i Pacific University, Honolulu, Hawaii, USA
| | | | - Francisco Maio Matos
- Hospitais da Universidade de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Coimbra University, FMUC, Coimbra, Portugal
- Clinical Academic Center of Coimbra, CACC, Coimbra, Portugal
| | - Barry Issenberg
- University of Miami Miller School of Medicine, Miami, FL, USA
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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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Maestre JM, Rojo E, Del Moral I. Future directions for simulation in healthcare: A critical review. J Healthc Qual Res 2024; 39:120-125. [PMID: 38176996 DOI: 10.1016/j.jhqr.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/01/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024]
Abstract
There was a widespread discontinuation of simulation programs during and after the COVID-19 pandemic. The objective is to explore how to facilitate greater integration of simulation in healthcare organizations. A literature review was conducted in PubMed, MEDES, IBECS and DOCUMED databases. Twenty-three articles published after the pandemic were selected, categorized in seven themes and critically reviewed. In order to consistently and fully integrate simulation into the organizational culture it is recommended to prioritize the development of new strategies that enhance the efficiency and safety of healthcare delivery. And also strategies that enhance the satisfaction and well-being of all stakeholders.
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Affiliation(s)
- Jose M Maestre
- Hospital Virtual Valdecilla, Avda. de Valdecilla s/n, 39008 Santander, Spain.
| | - Elena Rojo
- Hospital Virtual Valdecilla, Avda. de Valdecilla s/n, 39008 Santander, Spain
| | - Ignacio Del Moral
- Hospital Virtual Valdecilla, Avda. de Valdecilla s/n, 39008 Santander, Spain
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Silva BM, Norte G, Lito P, Garcia P. Mapping the Landscape: Simulation Centers in Portugal. Cureus 2024; 16:e56278. [PMID: 38623142 PMCID: PMC11018257 DOI: 10.7759/cureus.56278] [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] [Accepted: 03/16/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION Simulation-based training has emerged as a vital component of healthcare education. This study aims to characterize Portuguese simulation centers concerning their geographic distribution and key features, providing stakeholders with valuable insights to inform strategic decisions. METHODS A cross-sectional survey-based study was conducted over two years (2021-2023) to investigate the geographical dispersion and characteristics of simulation centers in Portugal. Descriptive statistics and thematic analysis were used to analyze data. RESULTS Twenty-three Portuguese simulation centers were included. Major urban areas and coastal regions bring together 20 simulation centers (86.96%). A large percentage (71.93%) of centers were affiliated with academic institutions, while five centers (21.74%) were clinically affiliated. Emergency care, Anesthesiology and Intensive Medicine, Pediatrics, and Gynecology and Obstetrics were identified as the national key areas of intervention. DISCUSSION Significant geographical disparity raises concerns about unequal access to professional training opportunities using simulation. Centers should be encouraged to incorporate developing technologies and innovative pedagogical methodologies and to expand their training repertoire into relatively uncharted territories. CONCLUSION Several issues have been identified within the national simulation network. Stakeholders and policymakers should prioritize equitable access, bolster the prevalence of clinical affiliated centers, foster innovation, and facilitate strategic coordination.
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Affiliation(s)
- Bruno Miguel Silva
- Medical Oncology Department, Hospital de Loures, Unidade Local de Saúde de Loures-Odivelas, Loures, PRT
- Pathophysiology Department, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, PRT
| | - Gustavo Norte
- Anesthesiology Department, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, PRT
| | - Pedro Lito
- Critical Care Unit, Unidade Local de Saúde da Cova da Beira, Covilhã, PRT
- Medical Sciences Department, Universidade da Beira Interior, Covilhã, PRT
| | - Pedro Garcia
- Neonatal Intensive Care Unit, Hospital de Dona Estefânia, Unidade Local de Saúde São José, Lisboa, PRT
- Pediatrics Department, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, PRT
- Simulation Center, CUF Academic Center, Lisboa, PRT
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Rose C, Chan T. Invisibility, cloaks and daggers: Balancing clinical hazards in the age of artificial intelligence. J Eval Clin Pract 2024; 30:9-11. [PMID: 36071693 DOI: 10.1111/jep.13758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Christian Rose
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Teresa Chan
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
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Smith-Millman M, Daniels L, Gallagher K, Aspinwall S, Brightman H, Ubertini G, Borrero GU, Palmo L, Weinstock P, Allan C. Hazard Assessment and Remediation Tool for Simulation-Based Healthcare Facility Design Testing. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:287-305. [PMID: 37545401 DOI: 10.1177/19375867231188151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
OBJECTIVES To develop an objective, structured observational tool to enable identification and measurement of hazards in the built environment when applied to audiovisual recordings of simulations by trained raters. BACKGROUND Simulation-based facility design testing is increasingly used to optimize safety of healthcare environments, often relying on participant debriefing or direct observation by human factors experts. METHODS Hazard categories were defined through participant debriefing and detailed review of pediatric intensive care unit in situ simulation videos. Categories were refined and operational definitions developed through iterative coding and review. Hazard detection was optimized through the use of structured coding protocols and optimized camera angles. RESULTS Six hazard categories were defined: (1) slip/trip/fall/injury risk, impaired access to (2) patient or (3) equipment, (4) obstructed path, (5) poor visibility, and (6) infection risk. Analysis of paired and individual coding demonstrated strong overall reliability (0.89 and 0.85, Gwet's AC1). Reliability coefficients for each hazard category were >0.8 for all except obstructed path (0.76) for paired raters. Among individual raters, reliability coefficients were >0.8, except for slip/trip/fall/injury risk (0.68) and impaired access to equipment (0.77). CONCLUSIONS Hazard Assessment and Remediation Tool (HART) provides a framework to identify and quantify hazards in the built environment. The tool is highly reliable when applied to direct video review of simulations by either paired raters or trained single clinical raters. Subsequent work will (1) assess the tool's ability to discriminate between rooms with different physical attributes, (2) develop strategies to apply HART to improve facility design, and (3) assess transferability to non-ICU acute care environments.
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Affiliation(s)
| | - Lorraine Daniels
- Enterprise Project Management Office, Boston Children's Hospital, MA, USA
| | - Katie Gallagher
- Enterprise Project Management Office, Boston Children's Hospital, MA, USA
| | - Sarah Aspinwall
- Cardiovascular Program, Nursing Patient Services, Boston Children's Hospital, MA, USA
| | - Howard Brightman
- Enterprise Project Management Office, Boston Children's Hospital, MA, USA
| | - Gina Ubertini
- Cardiovascular Program, Nursing Patient Services, Boston Children's Hospital, MA, USA
| | | | - Lobsang Palmo
- Immerisve Design Systems, Boston Children's Hospital, MA, USA
| | - Peter Weinstock
- Immerisve Design Systems, Boston Children's Hospital, MA, USA
- Department of Anesthesia, Pain, and Critical Care Medicine, Boston Children's Hospital, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, MA, USA
| | - Catherine Allan
- Immerisve Design Systems, Boston Children's Hospital, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, MA, USA
- Division of Cardiac Intensive Care, Department of Cardiology, Boston Children's Hospital, MA, USA
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Schwalbe D, Timmermann C, Gregersen TA, Steffensen SV, Ammentorp J. Communication, Cognition and Competency Development in Healthcare: A Model for Integrating Cognitive Ethnography and Communication Skills Training in Clinical Interventions. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205231223319. [PMID: 38204973 PMCID: PMC10777782 DOI: 10.1177/23821205231223319] [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] [Received: 02/02/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES The aim of this study was to conduct and evaluate the Blended Learning communication skills training program. The key objective was to investigate (i) how clinical intervention studies can be designed to include cognitive, organizational, and interactive processes, and (ii) how researchers and practitioners could work with integrated methods to support the desired change. METHODS The method combined design and implementation of a 12-week Blended Learning communication skills training program based on the Calgary-Cambridge Guide. The training was implemented in a patient clinic at a Danish university hospital and targeted all healthcare professionals at the clinic. Cognitive ethnography was used to document and evaluate healthcare professionals' implementation and individual competency development, and support the design of in-situ simulation training scenarios. RESULTS Thirteen participants completed the program. The synergy within the teams, as well as the opportunities for participants to coordinate, share, discuss, and reflect on the received knowledge with a colleague or on-site researcher, affected learning positively. The knowledge transfer process was affected by negative feedback loops, such as time shortages, issues with concept development and transfer, disjuncture between the expectations of participants and instructors of the overall course structure, as well as participant insecurity and a gradual loss of motivation and compliance. CONCLUSION We propose a novel 3-step model for clinical interventions based on our findings and literature review. This model will effectively support the implementation of educational interventions in health care by narrowing the theory-practice gap. It will also stimulate desired change in individual behavior and organizational culture over time. Furthermore, it will work for the benefit of the clinic and may be more suitable for the implementation of communication projects than, for example, randomized setups.
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Affiliation(s)
- Daria Schwalbe
- Center for Human Interactivity, Department of Culture and Communication, University of Southern Denmark, Odense, Denmark
- Centre for Human Interactivity, Department of Language, Culture, History and Communication, University of Southern Denmark, Odense, Denmark
- Centre for Culture and the Mind, Department of English, Germanic and Romance Studies, University of Copenhagen, Copenhagen, Denmark
| | - Connie Timmermann
- Center for Human Interactivity, Department of Culture and Communication, University of Southern Denmark, Odense, Denmark
| | - Trine A Gregersen
- Center for Human Interactivity, Department of Culture and Communication, University of Southern Denmark, Odense, Denmark
| | - Sune Vork Steffensen
- Centre for Human Interactivity, Department of Language, Culture, History and Communication, University of Southern Denmark, Odense, Denmark
- Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
- Center for Ecolinguistics, South China Agricultural University, Guangzhou, China
- College of International Studies, Southwest University, Chongqing, China
| | - Jette Ammentorp
- Center for Human Interactivity, Department of Culture and Communication, University of Southern Denmark, Odense, Denmark
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Spence T, Nikitovic D, Duncan D, Menzies S, Zadunayski A, Brindle M, Blackwood J. Designing and maintaining a rescue extracorporeal life support program: A holistic simulation approach. Perfusion 2023:2676591231225717. [PMID: 38156424 DOI: 10.1177/02676591231225717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Rescue Extracorporeal Life Support Programs based at non-cardiac surgery centers have unique needs to be able to ensure successful outcomes despite low patient volumes. In this paper we describe the important role simulation had in each stage of development, implementation, and maintenance of our pediatric Rescue ECLS Program. Systems-focused simulations were used to develop robust workflows, processes, and bundles. Simulation-based education targeted the acquisition and maintenance of clinical skills for individual team members, bringing together a multidisciplinary team of local clinicians who do not routinely perform pediatric cannulation related tasks. Translational simulation ensured continued improvement by addressing adverse events or latent safety threats observed during system-focused or educational simulations. Realism of all simulations was our priority, and was achieved through in situ simulations, participation of multidisciplinary teams, use of real equipment and medical supplies, and use of a high-fidelity cannulation manikin. This holistic simulation approach allowed us to overcome the barriers to high quality care, and maintain outcomes comparable to high volume centers. A similar approach can help other centers design simulation for their own Rescue ECLS Program, and can be translated to other high-risk and high-acuity critical care programs.
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Affiliation(s)
- Tanya Spence
- Pediatric Intensive Care Unit. Alberta Children's Hospital, Calgary, AB, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Associate Chief Nursing Office, Alberta Health Services, Calgary, AB, Canada
| | - Dejana Nikitovic
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Donovan Duncan
- Pediatric Intensive Care Unit. Alberta Children's Hospital, Calgary, AB, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Steve Menzies
- Department of Cardiac Surgery, Foothills Medical Center, Calgary, AB, Canada
| | - Anna Zadunayski
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mary Brindle
- Pediatric Intensive Care Unit. Alberta Children's Hospital, Calgary, AB, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jaime Blackwood
- Pediatric Intensive Care Unit. Alberta Children's Hospital, Calgary, AB, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Brazil V, Purdy E, El Kheir A, Szabo RA. Faculty development for translational simulation: a qualitative study of current practice. Adv Simul (Lond) 2023; 8:25. [PMID: 37919820 PMCID: PMC10621189 DOI: 10.1186/s41077-023-00265-0] [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: 07/26/2023] [Accepted: 10/13/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Translational simulation is focused directly on healthcare quality, safety, and systems. Effective translational simulation design and delivery may require knowledge and skills in areas like quality improvement and safety science. How translational simulation programs support their faculty to learn these skills is unknown. We aimed to explore current faculty development practices within translational simulation programs, and the rationale for the approaches taken. METHODS We used a qualitative approach to explore faculty development in translational simulation programs. We conducted semi-structured interviews with representatives who have leadership and/or faculty development responsibilities in these programs and performed a thematic analysis of the data. RESULTS Sixteen interviews were conducted with translational simulation program leaders from nine countries. We identified three themes in our exploration of translational simulation faculty development practices: (1) diverse content, (2) 'home-grown', informal processes, and (3) the influence of organisational context. Collaboration beyond the historical boundaries of the healthcare simulation community was an enabler across themes. CONCLUSION Leaders in translational simulation programs suggest a diverse array of knowledge and skills are important for translational simulation faculty and report a range of informal and formal approaches to the development of these skills. Many programs are early in the development of their approach to faculty development, and all are powerfully influenced by their context; the program aims, structure, and strategy.
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Affiliation(s)
- Victoria Brazil
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.
| | - Eve Purdy
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Alexander El Kheir
- Emergency Department, Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
| | - Rebecca A Szabo
- Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
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Ospel JM, Dmytriw AA, Regenhardt RW, Patel AB, Hirsch JA, Kurz M, Goyal M, Ganesh A. Recent developments in pre-hospital and in-hospital triage for endovascular stroke treatment. J Neurointerv Surg 2023; 15:1065-1071. [PMID: 36241225 DOI: 10.1136/jnis-2021-018547] [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: 03/09/2022] [Accepted: 10/05/2022] [Indexed: 11/04/2022]
Abstract
Triage describes the assignment of resources based on where they can be best used, are most needed, or are most likely to achieve success. Triage is of particular importance in time-critical conditions such as acute ischemic stroke. In this setting, one of the goals of triage is to minimize the delay to endovascular thrombectomy (EVT), without delaying intravenous thrombolysis or other time-critical treatments including patients who cannot benefit from EVT. EVT triage is highly context-specific, and depends on availability of financial resources, staff resources, local infrastructure, and geography. Furthermore, the EVT triage landscape is constantly changing, as EVT indications evolve and new neuroimaging methods, EVT technologies, and adjunctive medical treatments are developed and refined. This review provides an overview of recent developments in EVT triage at both the pre-hospital and in-hospital stages. We discuss pre-hospital large vessel occlusion detection tools, transport paradigms, in-hospital workflows, acute stroke neuroimaging protocols, and angiography suite workflows. The most important factor in EVT triage, however, is teamwork. Irrespective of any new technology, EVT triage will only reach optimal performance if all team members, including paramedics, nurses, technologists, emergency physicians, neurologists, radiologists, neurosurgeons, and anesthesiologists, are involved and engaged. Thus, building sustainable relationships through continuous efforts and hands-on training forms an integral part in ensuring rapid and efficient EVT triage.
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Affiliation(s)
- Johanna M Ospel
- Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Neurointerventional Program, Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada
| | | | - Aman B Patel
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Martin Kurz
- Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Mayank Goyal
- Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada
| | - Aravind Ganesh
- Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Davies E, Montagu A, Brazil V. Recommendations for embedding simulation in health services. Adv Simul (Lond) 2023; 8:23. [PMID: 37798755 PMCID: PMC10557368 DOI: 10.1186/s41077-023-00262-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023] Open
Abstract
Aspirations to achieve quality and safety goals in health services through simulation have led to significant investments in simulation equipment, space and faculty. However, the optimal governance and operational models through which these resources are expertly applied in health services are not known. There is growing evidence supporting 'service' models for simulation. In these models, simulation activities are co-designed and delivered by a team of simulation experts in partnership with health service units, specifically targeting quality and safety goals. Embedded simulation specialist teams working within these programs offer benefits not fully captured by traditional models of health education or by traditional systems for quality and safety.In this article, we explore broad and specific recommendations for establishing a simulation consultancy service within an Australian metropolitan health service. We base these recommendations on a review of current Australian practice and healthcare simulation literature, and on a specific example within a large outer metropolitan health service. The broad domains discussed include (1) governance and leadership; (2) human resources; (3) principles and planning; (4) operationalise and evaluate and (5) look to the future.The recommendations recognise that healthcare simulation is moving beyond solely addressing individual learning outcomes. The value of simulation addressing organisation and system objectives through various simulation modalities is increasingly being explored and demonstrating value. There is a growing demand for translational simulation in these contexts, and a consequent requirement for organisations to consider how simulation services can be successfully operationalised. Recommendations included in this paper are discussed and described with the intent of facilitating a deeper appreciation of the complexities associated with, and opportunities afforded by, a well-integrated simulation service.
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Affiliation(s)
- Ellen Davies
- Adelaide Health Simulation, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.
| | - Adam Montagu
- Adelaide Health Simulation, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Victoria Brazil
- Translational Simulation Collaborative, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
- Gold Coast Health Simulation Service, Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
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Schram AL, Lindhard MS, Bie M, Gamborg ML, Toxvig N, Skov G, Jensen RD. Using simulation-based training during hospital relocation: a controlled intervention study. ADVANCES IN SIMULATION (LONDON, ENGLAND) 2022; 7:41. [PMID: 36527102 PMCID: PMC9758894 DOI: 10.1186/s41077-022-00237-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND During hospital relocations, it is important to support healthcare professionals becoming familiar with new settings. Simulation-based training seems promising and in situ simulation has been suggested as a beneficial educational tool to prepare healthcare professionals for relocation. This study aimed to investigate the impact of a simulation-based training intervention on health professionals´ readiness to work in their new environment, as well as investigate sick leave before and after relocation. METHODS The study was a controlled intervention study implemented at a university hospital in Denmark. Simulation was used to prepare employees for workflows prior to relocation. Before relocation, 1199 healthcare professionals participated in the in situ simulation-based training program. Questionnaires on readiness to perform were distributed to participants at pre-, post-, and follow-up (6 months) measurement. In addition, data on participants' sick leave was gathered from a business intelligence portal. To compare dependent and independent groups, paired and unpaired t tests were performed on mean score of readiness to perform and sick leave. RESULTS Compared to the control group, healthcare professionals participating in the intervention felt significantly more ready to work in a new hospital environment. As a measure of psychological wellbeing, register data indicated no difference in sick leave, when comparing intervention and control groups before and after participating in the in situ simulation-based training program. CONCLUSIONS Healthcare professionals felt significantly more ready to work in a new environment, after participating in the in situ simulation-based training program, indicating that the intervention supported healthcare professionals during relocations. This may mitigate feelings of uncertainty; however, further research is needed to explore such effects. TRIAL REGISTRATION The study was approved by The Regional Ethics Committee (no. 1-16-02-222-22).
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Affiliation(s)
- Anders Lund Schram
- grid.425869.40000 0004 0626 6125Corporate HR, MidtSim, Central Denmark Region, Aarhus, Denmark
| | | | - Magnus Bie
- grid.425869.40000 0004 0626 6125Corporate HR, MidtSim, Central Denmark Region, Aarhus, Denmark
| | - Maria Louise Gamborg
- grid.425869.40000 0004 0626 6125Corporate HR, MidtSim, Central Denmark Region, Aarhus, Denmark
| | - Neel Toxvig
- grid.425869.40000 0004 0626 6125Corporate HR, MidtSim, Central Denmark Region, Aarhus, Denmark
| | - Gitte Skov
- grid.154185.c0000 0004 0512 597XDepartment for Psychosis, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
| | - Rune Dall Jensen
- grid.425869.40000 0004 0626 6125Corporate HR, MidtSim, Central Denmark Region, Aarhus, Denmark
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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: 0] [Impact Index Per Article: 0] [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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14
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Gard J, Duong C, Murtagh K, Gill J, Lambe K, Summers I. Simulation translation differences between craft groups. ADVANCES IN SIMULATION (LONDON, ENGLAND) 2022; 7:22. [PMID: 35897047 PMCID: PMC9326431 DOI: 10.1186/s41077-022-00218-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/09/2022] [Indexed: 12/03/2022]
Abstract
Background Many simulation-based clinical education events (SBCEE) aim to prepare healthcare professionals with the knowledge, skills, and features of professionalism needed to deliver quality patient care. However, how these SBCEE learnings are translated into broader workplace practices by learners from different craft groups has not been described. Objectives To understand how learners from different craft groups (doctors and nurses) anticipate simulation-based learnings will translate to their workplaces and the process by which translation occurs. Design Qualitative descriptive study design using pre- and post-SBCEE questionnaires. Settings A large tertiary Australian hospital-based simulation centre that facilitates SBCEE for multi-professional graduate and undergraduate clinicians from 16 hospitals. Methods Participants who attended SBCEEs between May and October 2021 completed questionnaires at two touchpoints, on the day of attending a SBCEE and 6 weeks after. Based on a phenomenological approach, the study examined clinicians’ experiences in relation to simulation education, intended simulation learning use in the workplace, and perceived success in subsequently using these learnings to improve clinical outcomes. Qualitative inductive thematic data analysis was used to develop narratives for different learner cohorts. Results Three overarching themes were identified regarding simulation participants’ perceptions of the success of translating simulation learnings into the workplace. These were: scenario-workplace mirroring, self-assessment, and successful confidence. Doctor participants found it difficult to map SBCEE learnings to their workplace environments if they did not mirror those used in simulation. Nurses sought peer evaluation to analyse the effectiveness of their workplace translations, whereas doctors relied on self-assessment. Learners from both craft groups highly prized ‘confidence-building’ as a key indicator of improved workplace performance achieved through SBCEE learning. Conclusion A diverse range of factors influences healthcare workers’ experiences in translating simulation learnings to their workplace. To equip simulation learners to translate learnings from a SBCEE into their clinical practices, we suggest the following areas of focus: co-development of translation plans with learners during the delivery of an SBCEE including the indicators of success, above table discussions on the generalisability of learnings to different environments and contexts, smart investment in simulation outputs, and cautious championing of confidence-building.
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Affiliation(s)
- Jye Gard
- Monash University, Melbourne, Australia. .,Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia. .,Monash Simulation, Moorabbin Hospital, Melbourne, Australia.
| | - Chi Duong
- Monash University, Melbourne, Australia.,Monash Simulation, Moorabbin Hospital, Melbourne, Australia
| | - Kirsty Murtagh
- Monash University, Melbourne, Australia.,Monash Simulation, Moorabbin Hospital, Melbourne, Australia
| | - Jessica Gill
- Monash University, Melbourne, Australia.,Monash Simulation, Moorabbin Hospital, Melbourne, Australia
| | - Katherine Lambe
- Monash University, Melbourne, Australia.,Monash Simulation, Moorabbin Hospital, Melbourne, Australia
| | - Ian Summers
- Monash University, Melbourne, Australia.,Monash Simulation, Moorabbin Hospital, Melbourne, Australia
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15
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Adaptive single case design (ASCD). SCIENTIA MEDICA 2022. [DOI: 10.15448/1980-6108.2022.1.42370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Aims: single case designs (SCDs) can help us understand change in learning-related variables, such as knowledge and skill, at the level of an individual learner, at the level of a team or group of learners, or at the level of a situation or system. Adaptive single case design (ASCD) is a new model that integrates (i.) elements of methods of education, training, and assessment that, through research methods other than SCDs, have received solid empirical evidence in the research literature and (ii.) principles of SCDs that can facilitate the integration of research in everyday practice. The rationale behind ASCD is to allow rapid evidence-based decision making in the practice of education, training, and assessment, at the unit of analysis – individual, group, team, situation, or system – that is considered appropriate in the context at hand. Method: an ASCD algorithm is introduced and discussed in the context of change at the level of the individual, change in a group or team, and change in a situation or system. Results: ASCD can be used to understand change at each of the previously mentioned units of analysis at any number of units including a single unit (one individual, one team, or one situation or system), and this change can be used for research purposes as well. Conclusion: ASCD enables both evidence-based practical decision making and research without stringent demands on the number of learners, groups, teams, situations, or systems.
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16
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Chang TP, Elkin R, Boyle TP, Nishisaki A, Walsh B, Benary D, Auerbach M, Camacho C, Calhoun A, Stapleton SN, Whitfill T, Wood T, Fayyaz J, Gross IT, Thomas AA. Characterizing preferred terms for geographically distant simulations: distance, remote and telesimulation. Simul Healthc 2022. [DOI: 10.54531/drkq7209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Simulationists lack standard terms to describe new practices accommodating pandemic restrictions. A standard language around these new simulation practices allows ease of communication among simulationists in various settings.
We explored consensus terminology for simulation accommodating geographic separation of participants, facilitators or equipment. We used an iterative process with participants of two simulation conferences, with small groups and survey ranking.
Small groups (n = 121) and survey ranking (n = 54) were used with
This research has deepened our understanding of how simulationists interpret this terminology, including the derived themes: (1) physical distance/separation, (2) overarching nature of the term and (3) implications from existing terms. We further deepen the conceptual discussion on healthcare simulation aligned with the search of the terminologies. We propose there are nuances that prevent an early consensus recommendation. A taxonomy of descriptors specifying the conduct of
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Affiliation(s)
- Todd P Chang
- 1Division of Emergency Medicine & Transport, Children’s Hospital Los Angeles/Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rachel Elkin
- 2Division of Pediatric Emergency Medicine, New York-Presbyterian Morgan Stanley Children’s Hospital-Columbia University Irving Medical Center/Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Tehnaz P Boyle
- 3Division of Pediatric Emergency Medicine, Boston Medical Center/Boston University School of Medicine, Boston University, Boston, MA, USA
| | - Akira Nishisaki
- 4Division of Pediatric Critical Care, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Barbara Walsh
- 5Division of Emergency Medicine, Boston Children’s Hospital, Harvard University, Boston, MA, USA
| | - Doreen Benary
- 6Division of Pediatric Emergency Medicine, NYU Langone Medical Center, New York University, New York, NY, USA
| | - Marc Auerbach
- 7Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Cheryl Camacho
- 8Simulation and Outreach Education, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Aaron Calhoun
- 9Division of Critical Care, Norton Children’s Hospital, University of Louisville, Louisville, KY, USA
| | - Stephanie N Stapleton
- 10Department of Emergency Medicine, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
| | - Travis Whitfill
- 7Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Trish Wood
- 11Starship Child Health, Auckland, New Zealand
| | - Jabeen Fayyaz
- 12Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Isabel T Gross
- 13Division of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Anita A Thomas
- 14Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, WA, USA
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17
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Purdy E, Borchert L, El-Bitar A, Isaacson W, Bills L, Brazil V. Taking simulation out of its "safe container"-exploring the bidirectional impacts of psychological safety and simulation in an emergency department. Adv Simul (Lond) 2022; 7:5. [PMID: 35123580 PMCID: PMC8818167 DOI: 10.1186/s41077-022-00201-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Simulation facilitators strive to ensure the psychological safety of participants during simulation events; however, we have limited understanding of how antecedent levels of psychological safety impact the simulation experience or how the simulation experience impacts real-world psychological safety. METHODS We explored the experience of participants in an embedded, interprofessional simulation program at a large tertiary emergency department (ED) in Australia. We engaged in theoretical thematic analysis of sequential narrative surveys and semi-structured interviews using a previously derived framework of enablers of psychological safety in healthcare. We sought to understand (1) how real-world psychological safety impacts the simulation experience and (2) how the simulation experience influences real-world psychological safety. RESULTS We received 74 narrative responses and conducted 19 interviews. Simulation experience was both influenced by and impacted psychological safety experienced at the individual, team, and organizational levels of ED practice. Most strikingly, simulation seemed to be an incubator of team familiarity with direct impact on real-world practice. We present a model of the bidirectional impact of psychological safety and simulation within healthcare environments. CONCLUSION Our model represents both opportunity and risk for facilitators and organizations engaging in simulation. It should inform objectives, design, delivery, debriefing, and faculty development and firmly support the situation of simulation programs within the broader cultural ethos and goals of the departments and organizations.
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Affiliation(s)
- Eve Purdy
- Gold Coast University Hospital Emergency Department, Southport, Queensland, Australia.
| | - Laura Borchert
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Anthony El-Bitar
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Warwick Isaacson
- Gold Coast University Hospital Emergency Department, Southport, Queensland, Australia
| | - Lucy Bills
- Gold Coast University Hospital Emergency Department, Southport, Queensland, Australia
| | - Victoria Brazil
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
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18
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Moneypenny M, Weldon S, Hamilton C, Buttery A, Alinier G. ASPiH 2021 Conference - Moving Upstream: Using simulation to improve systems. Simul Healthc 2022. [DOI: 10.54531/wgmh9519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | - Sharon Weldon
- 4Institute of Lifecourse Development, University of Greenwich, London, UK
| | | | - Andy Buttery
- 8Health Education England, Kent, Surrey & Sussex, England
| | - Guillaume Alinier
- 10School of Health and Social Work, University of Hertfordshire, Hatfield, UK
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19
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Douros G. Learning means changing: What's changed? Emerg Med Australas 2021; 33:928-929. [PMID: 34459112 DOI: 10.1111/1742-6723.13857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Affiliation(s)
- George Douros
- Emergency Department, Austin Health, Melbourne, Victoria, Australia
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20
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Pillay T, Clarke L, Abbott L, Surana P, Shenvi A, Deshpande S, Cookson J, Nash M, Fawke J, Rasiah V, Cusack J. Optimising frontline learning and engagement between consultant-led neonatal teams in the West Midlands: a survey on the utility of an augmented simulation training technique. Adv Simul (Lond) 2021; 6:29. [PMID: 34454614 PMCID: PMC8401370 DOI: 10.1186/s41077-021-00181-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background In England, neonatal care is delivered in operational delivery networks, comprising a combination of the Neonatal Intensive Care (NICU), Local-Neonatal (LNU) or Special-Care Units (SCU), based on their ability to care for babies with different degrees of illness or prematurity. With the development of network care pathways, the most premature and sickest are mostly triaged for delivery in services linked to NICU. This has created anxiety for teams in LNU and SCU. Less exposure to sicker babies has resulted in limited opportunities to maintain expertise for when these babies unexpectedly deliver at their centre and thereafter require transfer for care, to NICU. Simultaneously, LNU and SCU teams develop skills in the care of the less ill and premature baby which would also be of benefit to NICU teams. A need for mutual learning through inter-unit multidirectional collaborative learning and engagement (hereafter also called neonatal networking) between teams of different designations emerged. Here, neonatal networking is defined as collaboration, shared clinical learning and developing an understanding of local systems strengths and challenges between units of different and similar designations. We describe the responses to the development of a clinical and systems focussed platform for this engagement between different teams within our neonatal ODN. Method An interactive 1-day programme was developed in the West Midlands, focussing on a non-hierarchical, equal partnership between neonatal teams from different unit designations. It utilised simulation around clinical scenarios, with a slant towards consultant engagement. Four groups rotating through four clinical simulation scenarios were developed. Each group participated in a clinical simulation scenario, led by a consultant and supported by nurses and doctors in training together with facilitators, with a further ~two consultants, as observers within the group. All were considered learners. Consultant candidates took turns to be participants and observers in the simulation scenarios so that at the end of the day all had led a scenario. Each simulation-clinical debrief session was lengthened by a further ~ 20 min, during which freestyle discussion with all learners occurred. This was to promote further bonding, through multidirectional sharing, and with a systems focus on understanding the strengths and challenges of practices in different units. A consultant focus was adopted to promote a long-term engagement between units around shared care. There were four time points for this neonatal networking during the course of the day. Qualitative assessment and a Likert scale were used to assess this initiative over 4 years. Results One hundred fifty-five individuals involved in frontline neonatal care participated. Seventy-seven were consultants, supported by neonatal trainees, staff grade doctors, clinical fellows, advanced neonatal nurse practitioners and nurses in training. All were invited to participate in the survey. The survey response rate was 80.6%. Seventy-nine percent felt that this learning strategy was highly relevant; 96% agreed that for consultants this was appropriate adult learning. Ninety-eight percent agreed that consultant training encompassed more than bedside clinical management, including forging communication links between teams. Thematic responses suggested that this was a highly useful method for multi-directional learning around shared care between neonatal units. Conclusion Simulation, enhanced with systems focussed debrief, appeared to be an acceptable method of promoting multidirectional learning within neonatal teams of differing designations within the WMNODN. Supplementary Information The online version contains supplementary material available at 10.1186/s41077-021-00181-1.
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Affiliation(s)
- Thillagavathie Pillay
- University Hospitals of Leicester NHS Trust, Leicester, UK. .,Faculty of Science and Engineering, RIHS, University of Wolverhampton, Wolverhampton, UK. .,College of Life Sciences, University of Leicester, Leicester, UK.
| | - Lynsey Clarke
- West Midlands Neonatal Operational Delivery Network, Solihull, UK.,University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Lee Abbott
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.,Faculty of Medicine and Health Sciences, University of Keele, Keele, UK
| | - Pinki Surana
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Asha Shenvi
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | | | - Joanne Cookson
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.,Faculty of Medicine and Health Sciences, University of Keele, Keele, UK
| | - Matthew Nash
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Joe Fawke
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Vishna Rasiah
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Jonathan Cusack
- University Hospitals of Leicester NHS Trust, Leicester, UK.,College of Life Sciences, University of Leicester, Leicester, UK
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