No Time to Train? The Use of Simulation to Develop a Pathway and Deliver Training for Emergency Surgery in Maternity During the COVID-19 Pandemic (1090-003938) (To be presented during the session entitled, Research Abstract Oral: COVID-19)
Start time: Friday, January 22, 2021, 2:00 PM End time: Friday, January 22, 2021, 3:00 PM Session Type: Research Abstracts (Completed Studies)
The COVID-19 pandemic presented healthcare workers with a challenge to provide safe clinical care to patients while also protecting staff who were coping with a dynamic and evolving situation. The use of simulation to model pathways and devise standard operating procedures (SOPs) is now more common in healthcare(1-4) . However, the COVID-19 pandemic presented the world with a very tight timeline to deliver and test SOPs. This was further complicated in labor and delivery units where there was no reduction in workload and minimal published experience during the preparatory phases. We sought to test the hypothesis that a combination of table-top and in-situ simulation could be used to devise a coherent multi-disciplinary team (MDT) approach to emergency surgery in maternity. Focusing on the highest risk operation to the parturient, fetus and staff we sought to answer the question: Can we safely perform an emergency cesarian section under general anesthetic in a parturient with COVID-19?
This program involved three phases each using a simulation technique: SOP development, SOP testing and team training. The first phase developed an SOP using a simulated table-top case informed by the current local and national guidance(5). The case was a parturient requiring a emergency Caesarean Section requiring GA. Each department contributed to the discussion by focusing on team-based requirements and those areas that were different from standard practice due to COVID-19. An in-situ simulation scenario was then designed to test this SOP. The debrief, run by experienced faculty in our simulation center, explored three themes: 1) timing and logistics 2) SOP feasibility and 3) candidate feedback. The modified simulation scenario was then used for regular in-situ simulation team training in our maternity unit. The aim was to run up to 2 sessions per day across 1-2 weeks.
Table-top: 10 team members from obstetrics, operating department, midwifery, neonatology, and anesthesia. Areas highlighted: • importance of early escalation of emergency care and strong multidisciplinary cooperation • rationalization of staff and equipment • the need for training in personal protective equipment (PPE) and increased staffing In-situ simulation: 17 participants (+ actor patient), 6 data collectors (+ infection control experts) and 7 passive observers. Outcomes included: • Good evidence of overall feasibility of the new protocol • Delivery of the simulated baby within the 30 min guideline (28 mins) • Recognition that neonatology team could be outside theatre • increased stress in team members using level 2 PPE in a critical clinical situation • limitations in communication in level 2 PPE • Patient feedback was positive despite the communication challenges The modified protocol was used in further in-situ simulations to train the 151 multidisciplinary staff over 2 weeks.
The initial phases of the COVID pandemic provided fertile ground for team consolidation and planning. Successful implementation of new SOPs requires engagement from all team members(3) and this was no exception. Early engagement at all levels of the MDT meant that deficits in training were identified, changes were adapted rapidly and innovations applied quickly. The in-situ simulations demonstrated to staff that it was possible to deliver a baby safely within the accepted timeframe and allowed the neonatal team to be distant from any aerosol generating procedures in theatre. Simulation has a great deal to offer in the improvement of system safety and is now more widely used in healthcare for this purpose(4,5). Our study has shown that a combination of simulation modalities can be used to design, test and embed new SOPs in a rapidly evolving and uncertain landscape. It is surely a technique that should become part of the “new normal”.