Using Interprofessional System Simulation to Identify Gaps and Solutions for COVID-19 Clinical Care Response and Maintenance of Readiness (1090-004160) (Research Abstract Professor Rounds: Group 7)
Start time: Friday, January 29, 2021, 1:00 PM End time: Friday, January 29, 2021, 2:00 PM Session Type: Research Abstracts (Completed Studies)
In novel emerging infectious disease outbreaks (example: Ebola), in situ interprofessional team simulation has been described in the training and iterative refinement of local guidelines and expertise of clinical teams. In situ system simulation allows different interprofessional clinical teams to rehearse, troubleshoot, and improve clinical care processes, donning and doffing of personal protective equipment, and drills to identify system gaps in care. Interprofessional team simulation is a vehicle to identify process and system latent threats, gaps in knowledge or skill, and identify solutions to problems by front-line clinical and non-clinical staff. We hypothesized that interprofessional team simulations of a wide variety of COVID19 patient presentations would result in increased comfort and knowledge of clinical teams, identify gaps in suggested incident command center protocols, and recommend solutions for providing safe clinical care.
A team of critical care clinicians and simulation educators were identified by the Critical Care and Emergency Department service lines to ensure safe collaborative care of COVID19 patients in early March 2020.Seven scenarios of varying acuity and challenges were created for the different presentation possibilities of COVID19 patients throughout our system. Simulation cases and post-simulation gap analyses were reported back to clinical leadership for rapid cycle improvement. Participants were all available clinical staff on both day and evening shifts at differing times based on availability of the educator team. We used QCPR Annie mannequin (Laerdal) in situ in Emergency Department, Radiology, Critical Care, and hospital floors at VA Pittsburgh.We used RRT mock code processes to capture non-clinical response providers (Police, Environmental Services, Staff Assistants).Recurring themes identified were organized into major areas Latent Safety Threats, Communication, and System Process.
We performed 14 COVID19 System Simulations from March-May 2020, involving 168 staff for a total of 312 learning hours. Our 3 major areas of concern identified were Donning/ Doffing PPE for Conservation Education, RRT Response, and Clinical Process. In an iterative fashion, we developed solutions for communication and process at the junctions of care between ED-Radiology, ED-ICU, and during RRT activations. We created new policy for RRT performance with team role modification, including the role of safety officer outside the clinical room to ensure staff PPE safety in donning and doffing, medication and communication adjuncts, and new PPE just-in-time video and static visual aids at point of care. We incorporated feedback and ideas from front line non-clinical and clinical staff, changed usual responsibilities in order to mitigate risk, developed protective plastic shields for transport, and identified communication concerns.
Using simulation as both the process (identification of latent threats and process improvements) and solution (just-in-time educational interventions and interprofessional team suggestions) for high stakes novel emerging pathogen clinical response is vitally important for all healthcare systems to maintain clinical preparedness. Inter-departmental and multi-specialty involvement increases the success of identifying system latent threats, testing new innovations in care, and enhancing staff engagement in a culture of safety. We hope that continued system simulation stemming from our COVID19 system analysis simulations will engender a new culture of using simulation as the vehicle for process improvement as the VA progresses in the culture of safety and a high-reliability organization.