Interdisciplinary Attitudes Surrounding the Perceived Value of Routine In Situ Simulation In the Emergency Department
Dr. Catherine Cox MPH, MD. Principal Investigator; Resident FM (Hfx Site)
Dr. Lucy Patrick MD MEd (candidate), Resident Emergency Medicine
Dr. Nick Sowers MD FRCPC, Assistant Professor Emergency Medicine Dalhousie, Medical Director QEII Simulation Bay and Emergency Medicine Simulation Lead, Supervising Investigator
Summary / Background:
In Emergency departments, clinical staff including doctors, nurses and paramedics are responsible for emergent care of critically ill or dying patients. This type of care is referred to as emergency resuscitation and is most often delivered by an interdisciplinary health care team of doctors, nurses and paramedics who all work concurrently on the same patient. Despite this complex responsibility, on-the-job training or practice opportunities during actual emergencies are relatively rare (since real life experience must be balanced with patient safety).
In order to work effectively and prepare for real life team based resuscitation, clinical staff practice artificial resuscitation after hours, on a patient simulator, in an artificial environment known as a simulation lab. This exercise is known as traditional simulation training. Currently, traditional simulation is the type of simulation exercised in the QEII Health Sciences Emergency Department.
Some suggest that traditional simulation poses important gaps in training when compared to real-life patient resuscitation since it ignores concepts such as the resource limitations in a busy department, time delays, the pressure of unexpected resuscitation (since traditional simulation is planned) and the ability to ignore safety/ equipment protocols.
Given these limitations, recent enthusiasm has sparked for a different type of simulation known as in situ simulation (ISS)—or simulation delivered in the real clinical environment targeting on duty staff (ex. in pod 2, during a shift). Much like a real resuscitation, ISS occurs at random/unexpected times during a shift. Cited benefits of ISS include improved transfer of knowledge and skills into real-world practice, as well as opportunities to identify latent safety threats and other workplace-specific issues. Perhaps the largest hypothesized drawback of ISS is that it could interfere with concurrent patient care (though there isn’t any existing literature currently to support this).
To date there is no study that explores interdepartmental attitudes around potential support (or lack there of) for routine ISS training. Since staff buy-in is essential for the success of any front-line programming, including ISS (Petrosonaik et al, 2017), insight into the perceived benefits and potential barriers/drawbacks of ISS by ED interdisciplinary staff could be beneficial when considering routine ISS implementation.
In order to help fill this important gap in the literature the Charles V Keating Emergency and Trauma Centre has recently received approval to run an ISS pilot program (consisting of five – eight In-situ simulations from March 2018 to October 2018).
The aim of this study is to determine interdisciplinary attitudes regarding the perceived benefits and barriers/drawbacks of an ISS pilot program in the Queen Elizabeth II Health Sciences Emergency Department. Since staff buy-in is essential for successful programming, it is imperative that we understand opinions about ISS training, both theoretically and practically. It is our hope that this study may provide insight with respect to determining potential support (or lack thereof) for routine ISS training programs that may be applied locally and perhaps across the country.
Study design will feature a mixed methods approach (qualitative and quantitative) using survey questionnaires that will be distributed to interdisciplinary ED staff (resident physicians, nurses, department paramedics and physicians) before, during and after the implementation of an ISS pilot project. If you are a clinical staff member at the QEII Emergency Department (and fall into the previously listed categories); please take time to complete this important survey if you have not already:
Ethics approval for this study has been received from the Nova Scotia Health Authority Research and Ethics Board.