Interdisciplinary in situ simulation-based medical education in the emergency department of a teaching hospital in Nepal

Abstract

Background Simulation is well established as an effective strategy to train health care professionals in both technical and nontechnical skills and to prevent errors. Despite its known efficacy, adequate implementation is restricted due to the financial burden in resource-limited settings like ours. We therefore pursued to introduce cost-effective in situ simulation (ISS) in the emergency department (ED) to explore its impact on perception and learning experience among multidisciplinary health care professionals and to identify and remediate the latent safety threats (LST). Methods This is a prospective cross-sectional study with a mixed method research design, which was conducted in the ED of Dhulikhel Hospital-Kathmandu University Hospital. The pretest questionnaire was used to determine baseline knowledge, attitude, and confidence of the staff. The ISS with minimal added cost was conducted involving multidisciplinary healthcare workers. The LSTs were recorded and appropriate remediation was performed. Voluntary post simulation feedback was collected after the sessions. Results Overall 56 staff participated in at least one of the 35 simulation sessions, among which 45 (80%) responded to the questionnaires`. Twenty participants (45.5%) were reluctant to use the defibrillator. The self-reported confidence level of using defibrillator was low 29 (64.6%). The knowledge score ranged from 0 to 8 with the median score of 3 and a mean of 3.29 ± 1.8. There was no statistically significant difference in knowledge scores among participants of different occupational backgrounds, previous training, duration of work experience, and previous use of a defibrillator. A total of 366 LSTs {individual (43%), medication (17%), equipment (4%), and system/team (36%)} were identified (10.45 LST per ISS). The overall feedback from the participants was positive. Eighty percent of participants reported increased skills to use a defibrillator, and 82% reported increased confidence for managing such cases. They also agreed upon the need and continuity of such type of simulation in their workplace. Conclusions The baseline knowledge score and the confidence level of the staff were low. Self-reported feedback suggested increased confidence level and teamwork skills after ISS. It promoted identification and remediation of latent safety threats. ISS serves as a cost-effective powerful educational model that can be implemented even in settings where finances and space are limited.

Simulation Education to Advance Emergency Medicine and Pediatric Critical Care in Nepal

“…Experiential learning, deliberate practice and the ability to provide immediate feedback are the primary advantages of simulation-based medical education. It is an effective way to develop new skills, identify knowledge gaps, reduce medical errors, practice teamwork communication and maintain infrequently used clinical skills with the overall goal of improving patient care [6]. Although simulation cannot replace clinical exposure as a form of experiential learning, it replicates real life situation and promotes learning without compromising patient safety.…”

COVID-19 Outbreak Response for an Emergency Department Using In Situ Simulation

“…Our project resonates with other studies looking at the use of in situ simulation to improve staff confidence level and teamwork skills. It also offers an opportunity to test the introduction of protocols, guidelines, and system changes, while observing for latent safety threats to their introduction and possible solutions [9].…”

<p>COVID-19 Emergency Department Protocols: Experience of Protocol Implementation Through in-situ Simulation</p>

“…The study demonstrated that ISS provides a unique opportunity to increase the confidence level and skills of multidisciplinary staff which was also demonstrated in our previous study. 20 Our previous experience with such pandemics was scarce. We had limited time to prepare for the increased surge of the suspected cases and safety of our staff was the major concern.…”

“…The simulations were conducted by the ED faculties who had past trainings and experience in conducting simulations. 20,29,30 For triage ISS, we designed case scenarios of the patients arriving in the ED falling under different triage categories (Supplement 3a). The triage personnel interviewed the simulated patients (SiP) portraying various case scenarios and the participants had to allocate the SiP to the appropriate zones ( Figure 3).…”

“…21 Our previous experience showed that LSTs are common. 20 The "rapid cycle deliberate practice" to focus on rapid acquisition of new skills through "learn while doing" by ISS builds staff preparedness in a timely manner for epidemic preparedness. 22,23 " 24 Several other protocols had been developed and implemented in the ED under this collaborative work.…”