AimsTo encourage multidisciplinary team learning by introducing Child & Adolescent Mental Health (CAMHS) in-situ simulation training.To provide focused Human Factors feedback through the expertise of senior airline pilots.MethodThe integration of the WingFactors in-situ simulation programme to multiple departments at Whittington Health NHS Trust has transformed the education landscape. The programme has received unanimously positive feedback, and the potential benefits for not only physical, but also mental health training, have been quickly recognised. A total of 90 simulations have been performed. A number of CAMHS scenarios have been designed with the primary aims of encouraging multidisciplinary training and increasing the focus on Human Factors in Psychiatry.Simulation scenarios were performed in real clinical environments with primed actors, thus enabling high-fidelity in-situ simulation. Immediate ‘hot’ debriefs were delivered by clinical faculty and uniformed airline pilots, with emphasis on psychological safety to encourage participation from all team members. The key learning points were then detailed in written documents and circulated to the wider team as a valuable learning resource.The first CAMHS simulation involved the acute management of a collapsed patient in the Emergency Department toilet, with a ligature tied around her neck and accompanied by a distressed patient. Another scenario addressed de-escalation techniques when dealing with a patient presenting with an overdose, who was threatening to leave the ward and posing potential risk to herself.ResultThe nature of these in-situ simulations enabled the multidisciplinary team to analyse practical considerations in the management of acute clinical situations. Scenarios were designed to focus on areas which had been identified as needing improvement for patient safety.The observations provided by airline pilots increased the focus on Human Factors training. A number of key themes were identified, including the importance of effective team-briefing, distraction management and task allocation. This is of particular significance when managing a distressed patient and anxious relative, in a busy high-stress clinical environment.ConclusionIn-situ simulation is a newly emerging concept in the field of Psychiatry, and the success of this programme has been highlighted through consistently positive feedback from participants, and nomination for the HSJ Award (Best Education Programme 2021). The involvement of airline pilots has promoted collaborative learning amongst the multidisciplinary team, and increased the focus on Human Factors in Psychiatry, clearly demonstrating the value of in-situ simulation training in this field.
The PED saw >80 neonates in November 2020, which matched the number seen the previous year.A large majority of neonates seen in the PED are well babies, with between 15-40% of those seen in 2020 diagnosed as 'No Abnormality Detected'. The proportion of well neonates from November 2019 -February 2020 was 13-24%, but this increased to 20-40% from March 2020 onwards.Diagnoses that remained consistent throughout the year were feeding problems making up 15-22% of the diagnoses, and jaundice making up between 5-13%. On average 5-10% of neonates were diagnosed with sepsis. A notable effect of the pandemic and the subsequent social distancing was the reduction in respiratory presentations. In a normal Autumn/ Winter such as November 2019 -February 2020, 20-35% of neonatal attendances were diagnosed as Bronchiolitis or Upper Respiratory Tract Infections. Whereas September-November 2020 saw just 9-11%.On average the PED discharges 30-50% of all neonates without any Paediatric Specialty input.From 2016-2020 the average number of neonates presenting to the PED has increased from 1-2 infants per day, to 3 infants per day. Conclusions The reduction in PED attendance seen during the 1st COVID-19 lockdown was not seen during the 2nd lockdown, and the number of neonates being booked into the Paediatric ED increased to near normal in November 2020 despite overall Paediatric ED attendances remaining low. The reduction in neonates presenting with respiratory illnesses is likely a direct result of social distancing. While the increase in the number of well neonates seen following the first UK lockdown coincides with the reduction in postnatal home visits, and a move towards virtual consultations in primary care. The Paediatric Emergency Department offers an unrestricted route of access to healthcare for new parents, with an average of 3 infants <28 days old attending the LGI Paediatric Emergency Department every day.
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