Objectives & Background The Department of Health recommends innovative, evidence-based, high quality simulation for learning.1
The focus in recent years has shifted to in-situ simulation (ISS) which is physically integrated into the clinical environment.
The development of ISS remains in its infancy with national variation in quality.2 Limited evidence-based standards along with powerful cultural and logistic challenges often impede implementation of this practice.3
We will describe the process in developing an ISS program in the ED and discuss the challenges. It is hoped this will be useful for other departments wishing to develop simulation.
Methods A multi disciplinary faculty was established. Faculty training needs were identified and local training supported. Quarterly faculty meetings were founded.
A training needs assessment survey with a safety and teamwork questionnaire was emailed to all ED staff. A program of fortnightly sessions was designed in line with this, alternating adults and paediatrics. Scenario development was based on the RCEM curriculum, problematic events in the ED and observed learning needs.
Simulations varied in level of fidelity, timing and location within the ED. Scenarios progressed to involve cross-specialty.
Simulations commenced with a pre-briefing and lasted around 20 minutes followed by a 20 minute debrief. Debriefs were structured around a standard format incorporating clinical and non technical elements. Following each session participants completed an evaluation questionnaire (figure 1). During the scenario faculty noted observed latent safety threats on a template adapted from the NPSA contributory factors framework (figure 2). Identified latent threats were reviewed and escalated, including incident reporting.
Results The ISS program over the first year delivered 22 sessions to 86 participants with a good spread of participation across the team (figure 3).
Participant feedback demonstrated the positive impact of ISS on team working, communication, technical skills and overall practice (figure 4).
The identified latent threats covered a variety of contributory factors (figure 5).
The main obstacle encountered relates to cancelling sessions due to service delivery needs.
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