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59 Evolution of an in-situ simulation program for departmental induction in the critical care department
  1. Jonathan Aron JPA1,
  2. Broom CWB2,
  3. Vargulescu RXV1
  1. 1St Georges Hospital NHS Foundation Trust, UK
  2. 2GAPS Centre, St George’s Hospital NHS Foundation Trust ,UK

Abstract

Introduction Intensive care medicine is uniquely challenging due to complex environmental, human and situational challenges, in addition to clinical complexities. Frequently rotating junior doctors require induction and rapid integration into this environment.

A programme to meet an educational need designed to teach doctors and nurses about emergency tracheostomy management was instigated. This evolved from a mainly clinical endeavour, to an in-situ, multi-disciplinary method to induct new doctors to the unit.

Methods We undertook an in-situ simulation scenario in the ICU. A period of manikin familiarisation with the bedside nurse was undertaken by a facilitator as part of the morning examination. The scenario was purposefully ambiguous allowing for clinical judgement, conversation and escalation to be explored. Staff on the unit answered the call for help when issued. 3 members of faculty were observing. Afterwards a 15 minute debriefing session was conducted exploring issues surrounding team-working, communication, situational awareness and forward-planning. A questionnaire was conducted after the session.

Results 9 people participated in the final simulation, 4 nurses and 5 doctors.

A mean of 3.3 days (range 1–7) is needed to identify the location of emergency equipment. A mean of 30.7 days (range 4–90) is needed to get to know new colleagues and a mean of 31.4 days (range 7–90) is needed to get to know established members of staff.

Qualitative analysis of the responses to open questions is summarised in table 1.

View this table:
Abstract 59 Table 1

Conclusions The utility of MDT in-situ simulation training appears to extend beyond the remit of emergency clinical management.

A simple teaching intervention for the management of tracheostomy in critical care subsequently resulted in other learning outcomes being described by the learners on evaluation. Social and environmental learning points led us to evolve this intervention into becoming an induction to critical care as an orientation tool.

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