COVID-19 pandemic preparation: using simulation for systems-based learning to prepare the largest healthcare workforce and system in Canada

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 km 2), 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.

COVID-19 Critical Care Simulations: An International Cross-sectional Survey

“…Some simulation centers reported conducting more than 100 COVID-19 simulation scenarios, both in situ and in their simulation labs [19]. When centralized regional COVID-19 simulations were implemented, the number of simulations was rapidly increased to more than 400 acute care simulation session requests across Alberta's broad geographical zones within ve weeks [20].…”

“…Besides, there were challenges with providing basic life support and institutional COVID-19 policy and procedures. A recent nationwide Canadian study identi ed many similar ndings and challenges across urban and rural health care settings and addressed simulation-based education to achieve system-based learning [20].…”

Translational simulation: from description to action

“…The COVID-19 pandemic presented health services with the need for rapid and high stakes change to processes, workflows, teamwork, and physical spaces to prevent the spread of infection. Well-established translational simulation programmes strongly aligned with health service priorities were able to nimbly develop strategies to support these changes [ 20 – 22 , 61 ], including an outstanding example delivered at a provincewide level in Canada [ 62 ]. Given the likelihood of ongoing need for healthcare change and redesign in response to COVID-19, translational simulation approaches will remain critical.…”

Use of Virtually Facilitated Simulation to Improve COVID-19 Preparedness in Rural and Remote Canada

“…At the beginning of the COVID-19 pandemic, urban, suburban, rural, and remote centers were requesting SBE for disaster preparedness (Dubé et al, 2020a), but RRC proved particularly challenging to reach because in addition to budgetary constraints, the pandemic resulted in new public health guidelines and restricted travel (Government of Alberta, 2020). In order to facilitate COVID-19 preparedness training for RRC, existing simulation techniques were applied through a novel approach using entirely virtually-facilitated simulation (VFS) including virtual debriefing for communities with limited access to continuing medical education (Alberta Health Services eSIM Provincial Simulation Program, 2019; Cheng et al, 2020;Cheng et al, 2017;Ikeyama, Shimizu, & Ohta, 2012;Shao et al, 2017;INACSL Standards Committee, 2016).…”

“…(Eppich & Cheng, 2015;Dubé et al, 2019b). This blended approach, which was used throughout the province for COVID-19 SBE (Dubé et al, 2020a), allowed the facilitators to identify debriefing topics while providing actionable steps for local implementation and improvement ( Table 2). The lead facilitator began with a reactions phase, then targeted learner focused objectives (e.g.…”