Use of In Situ Simulation to Improve Emergency Department Readiness for the COVID-19 Pandemic

Abstract

Introduction: During the world-wide coronavirus disease 2019 (COVID-19) outbreak, there is an urgent need to rapidly increase the readiness of hospitals. Emergency departments (EDs) are at high risk of facing unusual situations and need to prepare extensively in order to minimize risks to health care providers (HCPs) and patients. In situ simulation is a well-known method used in training to detect system gaps that could threaten safety. Study Objectives: One objective is to identify gaps, test hospital systems, and inform necessary modifications to the standard processes required by patients with COVID-19 presenting at the hospital. The other objective is to improve ED staff confidence in managing such patients, and to increase their skills in basic and advanced airway management and proper personal protective equipment (PPE) techniques. Methods: This is a quasi-experimental study in which 20 unannounced mock codes were carried out in ED resuscitation and isolation rooms. A checklist was designed, validated, and used to evaluate team performances in three areas: donning, basic and advanced airway skills, and doffing. A pre- and post-intervention survey was used to evaluate staff members’ perceived knowledge of ED procedures related to COVID-19 and their airway management skills. Results: A total of 20 mock codes were conducted in the ED. Overall, 16 issues that posed potential harm to staff or patients were identified and prioritized for immediate resolution. Approximately 57.4% of HCPs felt comfortable dealing with suspected/confirmed, unstable COVID-19 cases after mock codes, compared with 33.3% beforehand (P = .033). Of ED HCPs, 44.4% felt comfortable performing airway procedures for suspected/confirmed COVID-19 cases after mock codes compared with 29.6% beforehand. Performance of different skills was observed to be variable following the 20 mock codes. Skills with improved performance included: request of chest x-ray after intubation (88.0%), intubation done by the most experienced ED physician (84.5%), and correct sequence and procedure of PPE (79.0%). Conclusion: Mock codes identified significant defects, most of which were easily fixed. They included critical equipment availability, transporting beds that were too large to fit through doors, and location of biohazard bins. Repeated mock codes improved ED staff confidence in dealing with patients, in addition to performance of certain skills. In situ simulation proves to be an effective method for increasing the readiness of the ED to address the COVID-19 pandemic and other infection outbreaks.

Impact of Personal Protective Equipment on the First-Pass Success of Endotracheal Intubation in the ED: A Propensity-Score-Matching Analysis

“…The role of simulation-based drills in the medical field is well established. These drills provide an opportunity for HCWs to rehearse high-risk procedures such as ETI for COVID-19 patients under real-world conditions [ 19 , 20 ]. They also enable HCWs to better understand their roles and responsibilities, improve communication among team members, and increase teamwork competencies while performing tasks.…”

Is in situ simulation in emergency medicine safe? A scoping review

“…2 55-57 We observed that even though the included studies were quite recent, as ISS seems to have emerged in the last 20 years, the vast majority used observational prospective designs. With ISS, the proximity between the intervention and the possible patient-centred outcomes is inspiring and educators should seek collaboration with methodologists to elaborate research protocols leaning Kirkpatrick level n (%) References KP4: patient outcome 22 Abulebda et al 29 Aljahany et al 76 Barni et al 112 Chan et al 31 Couto et al 36 Geis et al 72 Gray et al 42 Hamman et al 59 Hamman et al 60 Hargestam et al 61 Kerner RL et al 62 Kobayashi et al 63 Lavelle et al 113 Paltved et al 32 Patterson et al 10 Shah et al 37 Shrestha et al 34 Steinemann et al 40 Wang et al 114 Whitfill et al 69 Petrosoniak et al 75 Theilen et al 41 Walsh et al 68 KP5: costs 2 Theilen et al 41 Petrosoniak et al 75 Other, NA 10 Hunt et al 44 Kobayashi et al 52 Mondrup et al 33 Kessler et al 115 Siegel et al 43 Stevens et al 116 Wieck et al 117 Nadkarni et al 118 Auerbach et al 119 O'Leary et al 87 NA, not available.…”

Simulation Training for Hospital Admission of Patients With Covid-19: Assessment of Nursing Professionals

“…A survey 23 carried out in an emergency service, with a multidisciplinary team, assessed by simulation the basic and advanced skills for establishing airways in patients infected with COVID-19. Although most professionals perform the procedures correctly, about 21% did not follow the correct sequence and procedure for the use of personal protective equipment and hand hygiene.…”