In the last few months, the international scientific community has tried to share the experiences gained in the fight against Coronavirus.
Simulation has been reported several times as a tool to improve the interdisciplinary performance of the care teams and to identify system errors and latent hazards. Here some interesting examples.
In the last months, we all have read a lot about the novel coronavirus (SARS-CoV-2) also known as COVID‐19: from its genomic characterisation to the clinical management and treatment of confirmed cases.
Simulation is also playing its role in this fight against the virus and its pandemic effects. Simulation, in fact, has been reported as a tool not only to improve interdisciplinary performance of the care teams but also to identify system errors and latent hazards.
For those who missed them, here some interesting examples.
A good read!
[Wong J, et al. Preparing for a COVID-19 Pandemic: A Review of Operating Room Outbreak Response Measures in a Large Tertiary Hospital in Singapore. Can J Anaesth, 2020; 1-14.
Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7090449/]
According to a recent paper by Wong et al. (2020), in situ simulations were instrumental in identifying and resolving flaws in the response plan to COVID-19 at a large tertiary hospital in Singapore. Specifically, the authors designed and implemented a simulation scenario that required participants to perform resuscitation while wearing personal protection equipment (PPE) and powered air-purifying respirators (PAPR).
Under these conditions, the authors then looked for latent threats and potential problems of containment procedures and assessed the workflow and staff management in the operating room. Thanks to the data gathered during these simulation sessions, the anesthesiologists and surgeons were able to identify—and subsequently correct—several unexpected problems, including lack of supervision and coordination, environmental limitations, unsatisfactory equipment set-up, communication breakdowns, lack of familiarity with PPE usage and infection control breaches.
[Fregene TE, et al. Use of in situ simulation to evaluate the operational readiness of a high-consequence infectious disease intensive care unit. Anaesthesia. 2020. [Epub ahead of print].
Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/anae.15048]
Fregene et al. (2020) have recently described their experience gained by performing in situ simulations in a 34-bed Intensive Care Unit at the Royal Free Hospital in London. The sessions, conducted in a one day period in one of the four negative pressure isolation chambers of the ward, were developed and coordinated by 2 facilitators: one expert of infectious diseases and one consultant anesthetist with a long-standing experience in simulation training. The scenarios, which involved 4 participants at a time, were designed to verify the robustness of the procedures put in place to manage COVID-19 patients and train staff on how to don and doff PPE according to national guidelines and local protocols. These simulations unveiled a number of important latent risks, such as the lack of intubation equipment trolley for COVID-19 patients, the absence of a checklist or protocol for patient
pronation and the inability to read the posters with instructions for donning and doffing due to the small character size. Overall, the identification of these latent risks allowed the authors to plan corrective measures aimed to improve COVID-19 patient management.
[Lockhart SL, et al. Simulation as a tool for assessing and evolving your current personal protective equipment: lessons learned during the coronavirus disease (COVID-19) pandemic. Can J Anaesth. 2020. [Epub ahead of print]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7101597/]
As reported by Lockhart, et al. (2020) in situ simulation of a positive COVID-19 patient being intubated proved to be powerful tool for testing and adapting PPE, thereby improving staff safety with respect to standard guidelines. Furthermore, this training not only promoted careful and meticulous use of PPE even at the early stages of the emergency but also boosted staff morale, thereby strengthening the team effort.
[Carenzo L et al. Hospital surge capacity in a tertiary emergency referral centre during the COVID‐19 outbreak in Italy. Anaesthesia. 2020 Apr 4. doi: 10.1111/anae.15072. [Epub ahead of print]. Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/anae.15072]
Carenzo et al. (2020) have recently published their results on the training and in situ simulation sessions performed before the opening of a COVID-19 Intensive Care Unit. In two days, they were able to train 28 clinicians, 39 nurses and 10 health workers on how to adopt best practices for PPE usage as well as patient intubation, supination and pronation.
[Dieckmann P, et al. The use of simulation to prepare and improve responses to infectious disease outbreaks like COVID-19: practical tips and resources from Norway, Denmark, and the UK. Advances in simulation 2020; vol. 5 3. 16 Apr. 2020, doi:10.1186/s41077-020-00121-5. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160610/]
Dieckmann and collaborators present tips and resources for the use of simulation to respond to COVID-19 crisis. The authors describe tools which can be used to analyse needs, explain how simulation can help to improve responses to the emergency situations, how to integrate simulation into organisations, and key elements to pay attention when conducting simulations. They also provide an overview of helpful resources and scenarios to support centre-based and in situ simulations