Abbreviated in-situ inter-professional debriefing simulation training in peri-operative care environments: Minimizing the impact on clinical care using standardized videos

Abstract

Introduction

Our facility leadership posed questions to the perioperative leadership team regarding the presence of collaborative communication during the reconciliation of events occurring in several perioperative care areas (operating rooms {OR}, clinic procedure areas, Intensive Care Unit {ICU}). Our team* collaborated to pilot a rapid cycle performance improvement project focused on improving the effectiveness of debriefings and handoffs that could conceivably lead to more effective after-action reviews following events which were complicated by multiple simultaneous unexpected factors. We proposed we could implement standardized abbreviated low-fidelity point of care (in-situ) inter-professional simulation training across the healthcare system with minimal impact on clinical schedules. We believed this would improve the perception of teamwork and collaboration among surgical team members.

Methods

Inter-professional in-situ simulation training exercises were designed and performed in perioperative care areas systemwide at our three major facilities (Main hospital and two Healthcare Community Centers [HCC]). Multiple iterations of styles of training were conceived and trialed. In the end, preconstructed videos were used to standardize the processes that framed the simulation role-playing of a debriefing after a complex situation. These videos contain the pre-simulation pre-briefings, the clinical situation that preceded the clinical debriefing and the simulation debriefing. Successful reconciliation of the multiple events required team members to exercise closed-loop communication, mutual trust, reengagement, and de-escalation of disengaged team members. Anonymous institutional review board reviewed, and Association of Federal Government Employees (AFGE) approved retrospective pre/post implementation surveys were made available to participants immediately after and sixty to ninety days following simulation exercises.

Results

Between July 2023 and March 2024, one hundred and six staff in the perioperative care areas participated in twenty-two inter-professional simulation trainings (eleven OR, eight clinic, and three ICU simulations). Fourteen simulation scenarios in seven surgical disciplines were created. Eleven videos were produced covering cases in the O.R., clinic and ICU. Ultimately, the simulations were completed within twenty minutes in the three perioperative care clinical areas. Seventy-nine staff responded to the initial surveys after the simulation training. Eighty percent of the respondents gave favorable assessments regarding the effectiveness of the training in improving components of teamwork and agreed this program should continue.

Conclusions

The pilot program affirmed that we could implement simulations across the healthcare system in a format that minimally impacted the staffs’ clinical schedule. The process was standardized through the creation of multiple specialty specific videos. We proposed that perioperative team leadership could utilize these videos in the future to conduct spontaneously arranged simulations when they identified the presence of members naïve to this training and opportunities in the clinical schedule.

*Refer to the acknowledgments for construct of our perioperative leadership simulation advisory team