Oral Themed Presentation
Context: : Resuscitations in an emergency department (ED) often require teams to form emergently, without the opportunity to assign roles or communicate beforehand.1 In-hospital code and Rapid Response Teams (RRT) for hospitalized patients, face similar challenges.2–7 Simulation has previously been described as a method for orienting, evaluating the workload balance and assessing the structure of these teams.8-9 However, there is limited data or discussion in the literature about internal response systems within the emergency department, specifically interventions or simulations focused on how a team forms.
Our institution reviewed quality assurance videos of ED resuscitations. Several opportunities for improvement were identified: inconsistent response teams and roles, varying team member response times, inconsistent role assignment, unclear role expectations, crowding due to excessive staff response and potential staff shortages for other ED patients.
Our quality improvement (QI) process sought to utilize discrete, focused, interprofessional simulation, integrated into participant’s regular shifts, to systematically develop consistent response teams, times and role expectations.
Description: : Following AHRQ quality improvement process guidelines10, quality assurance video review of emergency responses identified improvement goals. Members of our ED QI and simulation team identified and selected a potential intervention: an interdisciplinary in situ simulation. Performance metrics were pre-identified: member response, response time, unintended responders. Intervention: High-frequency, brief (less than 5 minute duration - from simulation to conclusion of debrief and survey completion), in situ simulation sessions were conducted, utilizing Plan-Do-Study-Act (PDSA) cycles of refinement.10 Performance metrics were shared with staff and sustainment plans implemented.
Observation/Evaluation: : Participants completed surveys to provide feedback on team structure, composition, size and role clarity after each simulation session. Facilitators completed survey comments. Following the QI and PDSA cycles, team composition and role assignments were adjusted iteratively. On-going quality assurance review of clinical resuscitation events were assessed for performance metrics.
Discussion: : The brief session duration made it feasible for staff to attend during their clinical shifts without disrupting patient care and for a greater proportion of staff to participate. Extremely brief in situ simulation sessions were an effective strategy to implement and optimize the internal response team. Frequent mini-simulations conducted in situ may prove to be a valuable tool for the development and targeted refinement of resuscitation teams across a range of clinical settings. Improvements in consistent team member response, decreased response times and decreased unintended responders were witnessed in both simulation and clinical events.