A novel approach to operating room readiness for airborne precautions using simulation‐based clinical systems testing

Abstract

Background The emergence of the COVID‐19 disease as a global pandemic caused major challenges and strained busy operating room environments. This required institutions to rethink current system functioning and urgently develop safe medical practices and protocols. Purpose To use a novel approach combining simulation‐based clinical system testing with rapid cycle deliberate practice concepts for identifying latent safety threats presented by newly developed operating room COVID‐19 protocols and collecting frontline staff recommendations for mitigation. Methods This study design combined a training/education approach with probing the systems function. The primary outcomes were the number of latent safety threats and staff evaluations of this approach for feasibility and utility on immediate and four‐month post surveys. Participants started the simulation which took place in the operating room, in the assistant role before graduating to the primary airway manager. Simulation staff members observed the simulations and noted whether elements in the protocols/checklists were followed and whether latent safety threats were present using an observation form. Solutions to latent safety threats were sought during the debriefing period. Results This approach identified 17 latent safety threats not foreseen during the planning stages and allowed for corrections to the protocols prior to impacting patient outcomes. Post‐simulation surveys indicated that the program was well received and all who responded agreed that it was worth the time it took. Fifty‐seven percent of respondents to four‐month follow‐up survey reported using the work products to care for an actual COVID‐19 patient. Conclusions This study demonstrated a flexible methodology that effectively integrated simulation‐based training and systems tests to train staff and detect latent safety threats in the new workflows and provide recommendations for mitigation. While COVID was the specific prompt, this approach can be applicable in diverse clinical settings for training medical staff, testing system function, and mitigating potential latent safety threats.

A Novel Approach to Emergency Department Readiness for Airborne Precautions Using Simulation-Based Clinical Systems Testing

“…In contrast to our operating room COVID-19 simulation-based clinical systems test, in which we trained only 2 anesthesia staff members at a time with a single scenario, the ED is a much more complex system requiring testing with 5 scenarios, a larger number of providers at a time, and more detailed observation. 40 In both cases, our novel method combined rapid-cycle simulation training with a simulation-based clinical systems testing approach to define latent safety threats and develop responses. During this outbreak, the onsite simulation process was modified to take on a systems-based testing perspective.…”

“…We adapted the methods from our recent work in the operating room and developed 5 rapid onsite cycle ED simulation cases related to new protocols coupled with a structured observation tool. 40 The research team observed simulations logged adherence to protocols, identified latent safety threats, and participating staff were encouraged to provide input regarding potential solutions, and the case block was repeated with the suggested strategies. After each exercise, participants completed a web-based evaluation.…”

“…For debriefing and logging compliance with participant actions, we adapted the observation tool we used in the operating room to include questions for debriefing that focused on the new ED system modifications and personal protective equipment usage aligned with COVID-19 clinical care guidelines. 40 ( Appendix E1 , available online at http://www.annemergmed.com ). With emergency preparedness and infection control input, we modified the Promoting Excellence And Reflective Learning in Simulation debriefing approach for the Systems Integration model.…”

“…To focus on compliance (staff errors and/or omissions) with new workflows and uncover potential unique latent safety threats, we modified the observation tool we used in the operating room for the ED. 40 Three observers (CK, LE, and SW) underwent training sessions coordinated with scenario piloting. While observing each scenario, they specifically focused on identifying gaps/latent safety threats and, in debriefs, suggestions for remediation.…”

“…In a recent publication, we demonstrated this method for COVID-19 testing in the operating room. 40 To be effective requires creating a structured observation method focused on participants’ actions (the steps they should be taking) and focus debriefs with systems-level questions (What happened? What should happen?).…”