PG53 COVID 19 Intubation Simulation: Preparing for the new normal at UCLH

Background In situ simulation is an effective tool for rehearsing high risk situations (Patterson et al, 2013), detecting latent risks and testing operational readiness (Kobayashi et al, 2006). In anticipation of an influx of patients requiring intubation for COVID-19, we used simulation to identify and mitigate latent risks, rehearse team dynamics and improve staff confidence before the start of the pandemic. Summary of Project In March 2020, we delivered eleven in-situ simulations in the emergency department and the newly appointed intensive care overflow area in theatres. Participants were expected to perform a rapid sequence induction (RSI) using a new COVID-19 RSI checklist and airway grab box on an airway mannequin. Extra staff observed in active roles, delivering feedback on technical and non-technical skills. Post-simulation debrief identified learning points and latent threats requiring system changes. These were shared with staff dynamically throughout the process. We produced and distributed an exemplar video as an educational tool for those unable to attend. Feedback assessed how the training had influenced participants’ clinical practice and preparedness. Results Participants included anaesthetic, intensive care and emergency department doctors, nurses and operating department practitioners. Table 1 shows examples of learning points identified: Discussion Simulations were well attended. Debriefs yielded technical and non-technical learning points. Participants valued the opportunity to rehearse non-usual steps and communication in PPE. The majority reported reduced anxiety levels as a result of the training. Identified latent threats triggered revisions to policy, RSI checklist and airway grab box contents. Challenges included a need to preserve PPE, short preparation time and limited staff availability of both facilitators and participants due to ongoing elective work. Recommendations Our experience supports the use of in situ simulation for rapid staff training, as well as timely testing and refinement of new systems prior to clinical use in the context of the COVID-19 pandemic. Reference Kobayashi L, Shapiro MJ, Sucov A, Woolard R, Boss RM, Dunbar J, Sciamacco R, Karpik K and Jay G. Portable advanced medical simulation for new emergency department testing and orientation. Acad Emerg Med 2006;13(6):pp. 691–5. Patterson MD, Geis GL, Falcone RA, LeMaster T. and Wears RL. In situ simulation: detection of safety threats and teamwork training in a high risk emergency department. BMJ Qual Saf 2013;22(6):pp. 468–77.