Background Despite the absence of acute paediatric services sick children do still occasionally present to the Maidstone Hospital emergency department. As this occurs infrequently there is concern that staff may become deskilled at dealing with such cases. To address this issue a multidisciplinary in-situ simulation training programme in paediatric emergency admissions has been developed and implemented.
Methodology Sporadic multidisciplinary in-situ scenarios were run within the resuscitation area of the accident and emergency unit. Emergency department doctors and nurses, anaesthetists and paediatricians were included. The scenarios were adaptable dependent upon the performance and skills of the individuals and team involved. The scenarios were followed by a team debriefing session. Subjective feedback was obtained from participants
Outcomes The simulation faculty are focusing on the importance of human factors and crisis resource management in relation to paediatric emergencies. Participants also have the opportunity to refresh technical skills and clinical knowledge.
During this process we have become aware of a number of challenges posed by in-situ simulation. These include:
Transportation and set up of the simulator to the clinical area and the technical challenges this can pose.
Sourcing and provision of medical supplies and equipment for simulation training and the financing of these.
Unpredictability of the emergency department attendance volume leading to simulation events putting further pressure on already stretched resources or the resultant cancellation of simulation sessions.
Delay of actual patient care whilst simulation sessions are being conducted.
Unavailability of team members owing to other clinical commitments.
Cultural and psychosocial issues relating to performance anxiety.
Potential impact Our early experiences of in-situ simulation have shown the potential to significantly improve the recognition and management of paediatric emergencies.
Patterson MD, Blike GT, Nadkarni VM. In Situ Simulation: Challenges and Results. In: Henriksen K, Battles JB, Keyes MA, Grady ML, editors. Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 3: Performance and Tools). Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Aug
Miller KK, Riley W, Davis S, Hansen HE. In situ simulation: a method of experiential learning to promote safety and team behavior. J Perinat Neonatal Nurs 2008;22(2):105–13
Yager PH, Lok J, Klig JE. Advances in simulation for pediatric critical care and emergency medicine. Curr Opin Pediatr 2011;23(3):293–7
- Category: Course or curriculum evaluation/innovation/integration
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