Safety Considerations for In Situ Simulation in Closed SARS-CoV-2 Units

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic placed a tremendous strain on the healthcare system, which led to the deployment of new personnel into acute care settings, early graduation of medical students, and development of new treatment spaces. Education teams at the Montefiore Health System and New York Health and Hospitals/Jacobi Medical Center found simulation, both laboratory-based and in situ, critical to the training of medical staff and investigation of latent safety threats. Through our experience, we encountered unique infection control concerns based on in situ sessions, which prompted us to redesign our programs for the treatment of SARS-CoV-2. Using this experience, we outline our rationale for the use of in situ simulation for newly developed SARS-CoV-2 spaces along with recommendations on safety checks to consider before starting.

In Situ Simulation as a Tool to Longitudinally Identify and Track Latent Safety Threats in a Structured Quality Improvement Initiative for SARS-CoV-2 Airway Management

“…For the “Do” in PDSA, 10 simulations were performed in 2- to 3-week block intervals to consistently identify unique LSTs during each cycle. Video recording was purposefully not performed as an additional safety measure, as recommended by Jafri et al (2020) 19 . This was performed to limit the use of external equipment into closed units.…”

“…All simulations and debriefs were performed by a single simulation educator, the primary author, who also served as lead designer and trainer of the simulation and debriefs for the larger MISS-Q collaborative. 19 Simulations were performed in either a scheduled manner (at the end of the night shift or start of a day shift) or in the middle of a shift during a less-busy moment at the debriefer's discretion when working clinically. Simulations were conducted in one of the empty patient rooms in the ED including the usual staff in the unit participating in the same roles that they would normally be presented for an acute resuscitation.…”

“…It was purposefully not performed as an added safety precaution; reasons include avoiding unnecessary staff from entering closed units, restricting simulations to when the debriefer was working clinically, and limiting unnecessary equipment coming into and out of the closed unit. 19 In addition, we did not exclude staff who attended prior simulations. We designed the program to limit confounding from prior participation, focusing on threat identification, and keeping the case simple, using it in all 3 cycles.…”

Predictors for inpatient mortality during the first wave of the SARS-CoV-2 pandemic: A retrospective analysis

“…In April, the hospital developed and trained through medical simulation a highly skilled Critical Airway Team consisting of Anesthesiologists, Emergency Physicians, ICU Physicians and Respiratory Therapists [13]. This team managed over 80% of the intubations in the hospital and developed a higher threshold for intubation across the institution with the goal of increased utilization of other modalities for hypoxic patients including high flow nasal cannula and BiPAP.…”

Developing a simulation safety policy for translational simulation programs in healthcare

“…System integrity may be disrupted-fake medications given to real patients [3], staff pre-occupied with treating a manikin when real patients require attention, or emergency call systems activated by mistake. More recently, large volumes of simulation training have been conducted to test "COVID-19 safe" care processes [4,5], while ironically increasing the infection risks associated with gathering staff together for training, moving manikins between clinical spaces, and using personal protective equipment that may be in short supply for real patients [6].…”