Table 1

Design of the Heart Attack sequential simulation (SqS) and salient cues for subsequent group discussion

SqS sceneSqS participantsSalient cues for subsequent discussionLearning objectives
Patient collapsePatient, carer (trained actors)
  • Wife talking to husband about what they will have for lunch (bacon sandwich)

Lifestyle issues
Paramedic arrival and assessmentParamedics, patient, carer
  • Paramedics acquire information from patient and wife

  • Verbal handover via mobile phone from Paramedic to Coronary Care Unit  nurse

  • Wife allowed to travel in the ambulance with them

Identification of family support, triage approaches and patient–clinician communication
Paramedic transfer of patient to 24 hours heart attack treatment centreParamedics, patient, carer
  • Technical terminology between paramedics and Coronary Care Unit team (phone call)

Identification of family support
Handover between paramedics and cliniciansParamedic, patient, carer, nurse, clinician
  • Cardiologist reliant on paramedic and patient for information and decision-making

  • Limited support for wife

  • Technical terminology between paramedics and clinicians

  • Wife increasingly distressed

Identification of family support, triage approaches
Cath lab procedure and  waiting roomCath lab: patient, nurse, clinician
Waiting room: carer
  • Communication between clinicians and patient minimal

  • Wife not updated during this time

Identification of family support and patient–clinician communication
Ward consultationPatient, nurse, carer
  • Information of who will now be involved in the patient’s pathway given

  • Appropriate referrals made

  • Support to family not discussed

Identification of family support, triage approaches and patient–clinician communication