An extra patient on the ward round….

Background Widespread use of simulation is prohibited by interruption to clinical duties, high cost and inability to recreate nuances of real life environments1. In-situ simulation is the new paradigm because they are carried out within the actual clinical area.

Aim To develop multi-professional in-situ simulation program to teach common ICU problems and improve non-technical skills to function as a effective team in all situations.

Methods A simulated ICU bed space was recreated using our Laerdal SimMan EssentialTM, borrowed from our sim-centre, supplemented by real ICU equipment and drugs. Also actors are used for certain clinical situations. Junior and senior ICU doctors manage the same simulated patient through realistic events for 3 consecutive days in a week as a part of their ward round. After receiving a comprehensive handover, nurses conduct a clinical assessment and relay any priorities to the medical team on their arrival, or earlier if clinical situation demands. The team then reach a management plan or carries out any acute intervention. Following this a structured teaching debrief is conducted using FAST-PAGE2 model. The patient cases were developed with specific learning objectives and not confined to critical incidents or acute scenarios.

Results Staff including medical, nursing and other ICU professionals, envisaged simulation training could improve clinical decision making and interdisciplinary communication, especially during ward rounds and out-of-hours. The scenarios have reflected the usual ICU case mix and have included common general ICU patient journeys, with clinical crisis and maintenance issues. Early evaluation suggests the program is being well received, is enjoyable and meeting the aims. Feedback includes that the frequency of the program should be increased so that more staff can get this experience on a regular basis. This is not possible at present due to lack of unit specific simMan and not enough resources to involve more senior medical staff. It has been felt that more funding is required to have ICU specific simulation equipment, along with appropriate measures taken for senior medical and nursing staff to devote more time to carry out this program more frequently.

Conclusions Multi-disciplinary, low-budget in-situ simulation in an ICU is achievable which can deliver high value programs to meet clear educational goals within the routine working environment. More innovations are needed in the current climate of stretched resources to not only increase the frequency of such program but also to maintain the highest quality we are delivering by buying in more senior staff into this program. This remains a work in progress.

ICU light

References 1. Weinstock PH et al. Simulation at the point of care: reduced cost, in-situ

training via a mobile carry. Paediatric Critical Care Medicine 2005; 6:635-41 2. Dr Chris Nickson. The Alfred ICU Debrief system.

a. SimMan with Tracheostomy, b. artificial blood and blood products, c. SimMan with leg wound

T Woolard, A Mizen, J Whatling, A Sinha, K Bhowmick