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Staff participating in simulation
During the simulation exercises, Emergency Department staff interact with a high-fidelity manikin as if it is a real patient. (Photo: UHN)

It was a perfect illustration of the benefit of simulation education.

The Emergency Department (ED) Simulation Committee recently ran a case involving a chest tube insertion. During the session, it became clear that some junior nurses had not been exposed to the infrequent task of attaching the chest tube to the suction.

Fortunately, a senior nurse was on hand and took time to show them how to do it.

A few days later, the same team was on the job when a patient needed a chest tube inserted. This time, the procedure went seamlessly.

"It feels very valuable and worthwhile when we're able to identify these kinds of issues before they arise," says Nadia Farooki, Director of the UHN Simulation Committee.

In the high-stress environment of an ED, where decisions need to be made quickly, errors can occur when a healthcare team doesn't know how to effectively communicate with one another.

To address this problem, the ED Simulation Committee at UHN is aiming to improve interprofessional communication and patient safety by organizing simulation exercises in the resuscitation bay.

During the exercises, ED staff interact with a high-fidelity manikin as if it is a real patient. The manikin breathes, has palpable pulses and audible breath, and can even be programmed to cough, groan and speak.

"Anyone who takes a close look at the manikin can tell it isn't a real person, but we try to make the storyline as accurate as possible so it feels like a real-life scenario for those involved," says Roger Chow, Simulation Education Specialist.

20-minute cases integrated into clinical environment

In 1981, American researchers evaluated 28,000 incident reports submitted by pilots and air traffic controllers.  They found that more than 70 per cent involved errors that stemmed from issues with verbal communication, such as incomplete and inaccurate content, vague phrasing, absent communication and misperceived messages.

This study demonstrated the need for training on effective communication between interprofessional team members, particularly in high stakes environments like the airline industry and healthcare.

While the committee at UHN has been running mock code simulations over the past few years, they've found that many staff don't have the time to leave their clinical area to attend. The recent change to

20-minute cases integrated within the clinical environment – in situ – every couple of weeks has proven to be more realistic and much easier to coordinate.

Physicians typically have some experience with simulation training but other professions don't often have the chance to participate. Opening these opportunities to anyone means that residents, nurses, physician's assistants, respiratory therapists and more can practice together in a real-life setting.

"It's a better learning experience for everyone as it's less of a teaching session to see how you're doing and more of a team building session," says Soojin Yi, In Situ Simulation Coordinator.

These sessions also allow staff and Simulation Coordinators to identify latent safety threats (LSTs) before they can cause harm to real patients. LSTs are problems that arise when running a mock scenario, such as missing equipment, educational gaps or misunderstandings – anything that could potentially affect patient care.

"For physicians, I think knowing that we're working to improve the quality of patient care is a good motivating tool for them to find time to participate," says Nadia.

In addition to organizing training exercises, the Simulation Committee conducts research on how UHN can minimize LSTs from a systemic level.

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