PG53 COVID 19 Intubation Simulation: Preparing for the new normal at UCLH

• Published in: BMJ simulation & technology enhanced learning 2020-11, Vol.6 (Suppl 1), p.A59-A59
• Main Authors: English, Rose, Hill, Jeremy, Neun, Maximilian, Hulme, Anders, Collinson, Anna, Hoogenboom, Emilie Martinoni
• Format: Article
• Language: English
• Subjects: Coronaviruses; COVID-19; Intensive care; Intubation; Pandemics; Personal protective equipment; Simulation
• ISSN: 2056-6697
• DOI: 10.1136/bmjstel-2020-aspihconf.101

BackgroundIn situ simulation is an effective tool for rehearsing high risk situations (Patterson et al, 2013), detecting latent risks and testing operational readiness (Kobayashi et al, 2006).In anticipation of an influx of patients requiring intubation for COVID-19, we used simulation to identify and mitigate latent risks, rehearse team dynamics and improve staff confidence before the start of the pandemic.Summary of ProjectIn March 2020, we delivered eleven in-situ simulations in the emergency department and the newly appointed intensive care overflow area in theatres. Participants were expected to perform a rapid sequence induction (RSI) using a new COVID-19 RSI checklist and airway grab box on an airway mannequin. Extra staff observed in active roles, delivering feedback on technical and non-technical skills.Post-simulation debrief identified learning points and latent threats requiring system changes. These were shared with staff dynamically throughout the process. We produced and distributed an exemplar video as an educational tool for those unable to attend.Feedback assessed how the training had influenced participants’ clinical practice and preparedness.ResultsParticipants included anaesthetic, intensive care and emergency department doctors, nurses and operating department practitioners.Table 1 shows examples of learning points identified:DiscussionSimulations were well attended. Debriefs yielded technical and non-technical learning points. Participants valued the opportunity to rehearse non-usual steps and communication in PPE. The majority reported reduced anxiety levels as a result of the training. Identified latent threats triggered revisions to policy, RSI checklist and airway grab box contents.Challenges included a need to preserve PPE, short preparation time and limited staff availability of both facilitators and participants due to ongoing elective work.Abstract PG53 Table 1Examples of learning points identified Learning points Technical skills Need to meticulously check tubing connections to avoid inadvertent disconnections Non-technical skills Need to project voice whilst wearing personal protective equipment (PPE) Infection control Contamination occurred whilst doffing (due to crowding around bins) Policy/ checklist design Policy needed for decontaminating videolaryngoscope post intubation Equipment ED cubicles had only one oxygen outlet: not possible to pre-oxygenate on CPAP and switch to water’s circuit without prolonged disconnection