Traditional Poster Round
Context: : Patient safety in the operating theatre has been shown to be impacted upon by poor team work and communication errors (1). This is in addition to system errors (2) and unfamiliarity with rare emergencies (3). However, high fidelity simulation can be used as an educational tool and as method of testing latent weaknesses in protocols within a multiprofessional operating room environment (4).
Description: : Our group devised a monthly programme of in-situ, multiprofessional simulations of intra-operative emergencies across a variety of specialties. Using Gaumard Pediatric HAL and Laerdal SimJunior, high fidelity models, each simulation encompassed a scenario which has been reported in the literature, but not occurred at our institution in the previous 3 years. The simulations were streamed to a separate site for group observation and were followed by a formal teaching session on the local protocol.
The programme encompasses:
1. Cardiac arrest when prone
2. Air embolism in laparoscopic surgery
3. Can’t intubate, can’t ventilate (CICV)
4. Catastrophic haemorrhage
The candidates were not primed but the observing team was and each member was tasked with reviewing a particular aspect of the simulation; clinical decisions, adherence to local protocol, communication and teamwork, system errors.
Observation/Evaluation: : A formalised protocol was used for debrief and peer feedback was delivered by both the candidates and observing teams.
Likert scales were used to measure how confident each candidate and observer felt regarding management with each scenario before and after the simulation. We also requested free text reflection from staff regarding the scenario.
Results from the first simulation:
26 staff were involved, only 2 had any real life experience of the rare emergency scenario. Following the simulation: All 26 agreed that this was a difficult to manage scenario, 22/26 agreed (14 strongly) that they would be more confident in managing a similar case.
18/26 believed that peer feedback was a useful tool to enhance their learning. All staff felt that in-situ simulation was a useful exercise and enhanced learning;
“I felt nervous at the beginning, but very positive following the scenario…”
“It allowed us to identify problems that may arise during a similar scenario and practicing them would only be of benefit…”
(Figures 1 & 2)
Discussion: : This programme allows simulation of rare intraoperative emergencies which involves all members of the theatre team. Feedback from the first scenario reported improved knowledge and comfort with rare emergencies and allowed for in-situ testing of management protocols and the formation of new local policies. Improved teamworking and communication was reported by peer observation. Our group plan to expand the programme of high fidelity in-situ simulation to other environments within our hospital.