In-situ Simulation Use for Rapid Implementation and Process Improvement of COVID-19 Airway Management

Abstract

Introduction The coronavirus disease 2019 (COVID-19) pandemic presents unique challenges to frontline healthcare workers. In order to safely care for patients new processes, such as a plan for the airway management of a patient with COVID-19, must be implemented and disseminated in a rapid fashion. The use of in-situ simulation has been used to assist in latent problem identification as part of a Plan-Do-Study-Act cycle. Additionally, simulation is an effective means for training teams to perform high-risk procedures before engaging in the actual procedure. This educational advance seeks to use and study in-situ simulation as a means to rapidly implement a process for airway management in patients with COVID-19. Methods Using an airway algorithm developed by the authors, we designed an in-situ simulation scenario to train physicians, nurses, and respiratory therapists in best practices for airway management of patients with COVID-19. Physician participants were surveyed using a five-point Likert scale with regard to their comfort level with various aspects of the airway algorithm both before and after the simulation in a retrospective fashion. Additionally, we obtained feedback from all participants and used it to refine the airway algorithm. Results Over a two-week period, 93 physicians participated in the simulation. We received 81 responses to the survey (87%), which showed that the average level of comfort with personal protective equipment procedures increased significantly from 2.94 (95% confidence interval, 2.71–3.17) to 4.36 (4.24–4.48), a difference of 1.42 (1.20–1.63, p < 0.001). There was a significant increase in average comfort level in understanding the physician role with scores increasing from 3.51 (3.26–3.77) to 4.55 (2.71–3.17), a difference of 1.04 (0.82–1.25, p < 0.001). There was also increased comfort in performing procedural tasks such as intubation, from 3.08 (2.80–3.35) to 4.38 (4.23–4.52) after the simulation, a difference of 1.30 points (1.06–1.54, p < 0.001). Feedback from the participants also led to refinement of the airway algorithm. Conclusion We successfully implemented a new airway management guideline for patients with suspected COVID-19. In-situ simulation is an essential tool for both dissemination and onboarding, as well as process improvement, in the context of an epidemic or pandemic.

Rapid Dissemination of a COVID-19 Airway Management Simulation Using a Train-the-Trainers Curriculum

“…We developed a structured curriculum to teach appropriate donning and doffing of PPE and a modified airway management algorithm for suspected COVID-19 patients using in situ simulation. 8 , 9 The modified airway management algorithm and simulation scenario were developed by institutional leaders, including our initial trainer (C.H.H. ), who had experience in health care operations, education, and critical care.…”

“…), who had experience in health care operations, education, and critical care. 8 , 9 The algorithm was tested and revised multiples times using the plan–do–study–act process and feedback from its use in both the simulated and clinical environments. 8 , 9 Our prior work had demonstrated that learners achieved significant improvement in comfort with donning and doffing PPE, role identification, and AGP management for suspected COVID-19 patients after the in situ simulation.…”

“… 8 , 9 The algorithm was tested and revised multiples times using the plan–do–study–act process and feedback from its use in both the simulated and clinical environments. 8 , 9 Our prior work had demonstrated that learners achieved significant improvement in comfort with donning and doffing PPE, role identification, and AGP management for suspected COVID-19 patients after the in situ simulation. 8 The work we describe in this report focuses on the implementation of a structured train-the-trainers curriculum to disseminate material to multiple clinicians with consistent outcomes.…”

Airway management in COVID-19 : time to start thinking outside the box?

“…This requires extensive staff training, buddy systems, practice through simulation, and ongoing feedback to combat 'pandemic fatigue' . 39,40 With rigorous IPC practices, it may be possible to greatly limit or even prevent any staff infections in the workplace. 3…”

Airway Management of Critically Ill Pediatric Patients with Suspected or Proven Coronavirus Disease 2019 Infection: An Intensivist Point of View

“…recommendations by the scientific sections' collaborative of the european society of pediatric and neonatal intensive care. Pediatr Crit Care Med 2021;22(01):56-67 2 Álvarez Z P, Larios G G, Toro R L, et al Recommendation for the recognition, management and follow up of cardiovascular compromise in patients with pediatric multisystemic inflammatory syndrome associated with COVID-19 (PIMS-CT). Position statement of Chilean Scientific Societies [in Spanish].…”