by Vered Gazit, physician, Emergency Department and program director, Pediatric Simulation
I was in self isolation after returning from travel over March break. I was overwhelmed with emails, information and new procedures in the Emergency Department. I was dreading the moment my two weeks of isolation would be over and I would have to face this mountain of information. On my first day back I participated in one of our daily COVID-19 simulations in the ED. To my relief, I came out feeling it’s not as complicated as it seemed in all those emails that were piling up in my inbox. We’ve got this.
I think this is a typical response for Emergency Department (ED) staff after completing their first COVID-19 simulation session. One would make a false assumption that combining two anxiety provoking triggers together (COVID-19 and simulation) is a catastrophe waiting to happen. But in the ED we know better, with repetitive practice we can improve our setting, our process and boost our confidence.
“Elite performers practice 99 per cent of the time and perform 1 per cent of the time. These simulations are critical to successfully managing patients in our department. Learning to function with minimal staff physically present at the patient bedside really highlighted the need for clear communication with staff who are outside the room documenting care, paging staff, entering orders and preparing medications.”
– Katrina Hurley, chief, Emergency Department and head, Division of Pediatric Emergency Medicine
The ED has been running daily COVID-19 simulation since March 12. Our focus is to review our current procedures, challenge them, test them and make endless improvements. The simulation team together with the ED clinical leaders ensures that at the end of each session we make recommendations to improve the process and implement the changes. We go through this every day, sometimes at night, weekdays, weekends and holidays – every, single, day.
“The ED was a very early adopter of simulation based learning at the IWK – long before there was a simulation program! This speaks volumes about the passion and dedication to excellence in care that is so evident among the ED staff and physicians. Seeing is believing and that’s the magic of simulation.”
– Kathy Johnston, coordinator, IWK Simulation Program
We’ve learned so much over the past month:
- What equipment should be located inside the negative pressure room and what equipment should be available outside the room?
- What are the best ways to maintain constant communication between the team inside the room and the support staff outside the room?
- How do you best maneuver the patient’s bed outside through the ANTE room? Who should be in the room and who should we call for help?
These are just a few examples of the items that were ironed out through simulation.
So far we have trained the majority of the ED staff, at least once. We have collaborated with our partners from Respiratory Therapy and the new COVID Airway Team. But our work is not done and we have now expanded our simulation sessions to address other challenges.
We keep track of all the lessons learned so we can ensure we implement improvements in our future ED. We know that every minute we spend now on coming up with solutions to make our old space work will be our best tool designing our future ED.
“The team impresses me continually. They started simulations in our negative pressure room before most of the public health measures were put in place. The team has all taken part and we are now performing additional simulations with our second care area in shared clinics. It’s a true example of a team coming together in unusual circumstances to make sure we are ready to perform high-risk, low-frequency events.”
– Tanya Sheppard, manager, Emergency Department