Use of Video Simulation to Educate Emergency Medicine Residents on Intubation Protocol for Patients under Investigation for COVID-19 (1090-003793) (Research Abstract Oral: Virtual/Augmented Reality)
Start time: Monday, January 25, 2021, 9:30 AM End time: Monday, January 25, 2021, 10:30 AM Session Type: Research Abstracts (Completed Studies)
The novel coronavirus (COVID-19) has caused a widespread strain on healthcare systems worldwide since the declaration of the pandemic on March 11th, 2020 by the WHO. Healthcare teams have had to continually adapt to changing recommendations on patient management and protection measures. There is particular concern around the intubation of these patients as an aerosolizing generating procedure with a high risk of transmission to healthcare providers. (1) There is a distinct need to close any knowledge gaps for intubation procedures for the critically ill COVID-19 patient. With the current recommendations for social distancing, remote learning educational content is necessary. A video recorded in-situ simulation to develop a best practice video was created to increase knowledge and improve adherence to policies for patient and staff safety. We hypothesize that it would be an effective remote learning tool to prepare emergency medicine residents on the COVID airway procedure.
All third and fourth-year emergency medicine residents at a single site were sent a pre-assessment on the understanding of institutional recommendations for safe intubation practices for potential COVID-19 patients. After completion of the pre-assessment, they were sent a 10-minute video of an in-situ simulation demonstrating the intubating provider’s role in gathering the team, checking equipment, limiting in-room personnel, and unnecessary aerosolizing procedures during intubation of a COVID-19 patient which was represented by a high fidelity mannequin. The simulation included common adverse events such as failed intubation and hypotension. The residents then completed a post-assessment to review their understanding of key concepts in order to determine their preparedness to perform intubations on COVID-19 patients in the Emergency Department. The six-question pre-assessment and post-assessment were the same and were analyzed using Microsoft Excel with student t-test.
The six-question pre-assessment and post-assessment were the same and were analyzed using Microsoft Excel with a 2 tailed T-test. A total of 32 individuals participated in the educational intervention for 100% completion by all PGY-3 and PGY-4 residents. The median for the pre-assessment scores was 5. There was a significant improvement in post-assessment scores with a median of 6 (p<0.05). A total of 69% of residents achieved a perfect score on the post-assessment, improved from 25% on the pre-test. The residents also rated their comfort level with managing COVID intubations on a 10-point Likert scale and reported improvement in comfort from a median of 6.5 during the pre-assessment to a median of 8 on post-assessment (p<0.05).
Our education team strategized to determine the best and safest practices to train emergency medicine residents at Stanford University on the airway management of potential COVID-19 patients. Simulation is a widely accepted and effective format for procedural and team management training. The emergency medicine residents were highly motivated with the current COVID-19 pandemic to educate themselves on appropriate management of these patients, coupled with the consistent communication of institutional protocols likely contributed to 25% of the residents able to score perfectly on the pre-assessment initially. The increase in resident comfort with the management of these complex intubations was also improved. We conclude that during the COVID-19 pandemic with restrictions on in-person training, the use of a remote learning video simulation was effective in educating residents on necessary patient and provider safety protocols during intubation as well as increasing provider comfort.