Improving patient and clinician safety during COVID-19 through rapidly adaptive simulation and a randomised controlled trial: a study protocol

IntroductionCOVID-19 required healthcare systems to iteratively adapt for safe and up-to-date care as knowledge of the disease rapidly evolved. Rates of COVID-19 infections continue to fluctuate and patients without COVID-19 increasingly return to the emergency department (ED) for care. This leads t...

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Bibliographic Details
Published in:BMJ open 2022-05, Vol.12 (5), p.e058980
Main Authors: Evans, Leigh V, Ray, Jessica M, Bonz, James W, Joseph, Melissa, Gerwin, Jeffrey N, Dziura, James D, Venkatesh, Arjun K, Wong, Ambrose H
Format: Article
Language:English
Subjects:
ACCIDENT & EMERGENCY MEDICINE
Anxiety
Burnout
Burnout, Professional
Clinical trials
Coronaviruses
COVID-19
Emergency Medicine
Health care industry
Human influences
Humans
Infections
Medical personnel
MENTAL HEALTH
OCCUPATIONAL & INDUSTRIAL MEDICINE
Organisational development
Pandemics
Patient safety
Patient satisfaction
Physicians
Physiology
Protocols & guidelines
Randomized Controlled Trials as Topic
SARS-CoV-2
Simulation
Stress
Task forces
Teams
United States
Workers
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Summary:IntroductionCOVID-19 required healthcare systems to iteratively adapt for safe and up-to-date care as knowledge of the disease rapidly evolved. Rates of COVID-19 infections continue to fluctuate and patients without COVID-19 increasingly return to the emergency department (ED) for care. This leads to new challenges and threats to patient and clinician safety as suspected patients with COVID-19 need to be quickly detected and isolated among other patients with non-COVID-19-related illnesses. At the front lines, emergency physicians also face continued personal safety concerns and increased work burden, which heighten stress and anxiety, especially given the prolonged course of the pandemic. Burnout, already a serious concern for emergency physicians due to the cumulative stresses of their daily practice, may present as a longer-term outcome of these acute stressors.Methods and analysisWe will implement a rapidly adaptive simulation-based approach to understand and improve physician preparedness while decreasing physician stress and anxiety. First, we will conduct semi-structured qualitative interviews and human factor observations to determine the challenges and facilitators of COVID-19 preparedness and mitigation of physician stress. Next, we will conduct a randomised controlled trial to test the effectiveness of a simulation preparedness intervention on physician physiological stress as measured by decreased heart rate variability on shift and anxiety as measured by the State-Trait Anxiety Inventory.Ethics and disseminationThe protocol was reviewed and approved by the Agency for Healthcare Research and Quality for funding, and ethics approval was obtained from the Yale University Human Investigation Committee in 2020 (HIC# 2000029370 and 2000029372). To support ongoing efforts to address clinician stress and preparedness, we will strategically disseminate the simulation intervention to areas most impacted by COVID-19. Using a virtual telesimulation and webinar format, the dissemination efforts will provide hands-on learning for ED and hospital administrators as well as simulation educators.Trial registration number NCT04614844.
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2021-058980