Ep19 - In Situ and Guerrilla Sim in the ED

In Situ Simulation in Emergency Medicine: Insights from St. Emlyn's Welcome to the St. Emlyn's blog. I'm Ian Beardsell, and I'm Simon Carley. Today, we're exploring in situ simulation, a vital method for improving patient care and team efficiency in emergency medicine. I'll be discussing this at UCEM, and we want to share our insights on implementing it effectively in your department. What is In Situ Simulation? In situ simulation takes place in your clinical environment, such as the resuscitation room or patient cubicles. Unlike traditional simulation centers that require significant resources, in situ simulation happens where you work every day. This method allows teams to practice and refine their skills in the actual setting, making training more relevant and practical. Gorilla Simulation vs. In Situ Simulation Gorilla simulation, a subset of in situ simulation, involves an element of surprise. It means conducting unplanned simulations during odd hours to test spontaneous team responses. For instance, pressing the resus buzzer at 3 AM with no prior warning and having the team manage a mock patient. While gorilla simulation is riskier and more challenging, it provides valuable insights into team dynamics and readiness. The Importance of Simulation in Emergency Medicine Initially, many clinicians, including myself, were skeptical about the impact of simulation training. However, extensive research and our experiences at St. Emlyn's show that simulation significantly improves clinical skills, team coordination, and patient outcomes. Studies have demonstrated its effectiveness across various departments, and we've observed marked improvements in team behavior, organization, and efficiency since implementing regular simulation sessions. Overcoming Challenges in Simulation Training Not everyone is comfortable with simulation, especially those who are more introverted or less familiar with the process. It's essential to acknowledge this and create a supportive environment. Normalizing simulation as part of routine training helps, as does ensuring that initial sessions are positive and constructive. We learned through trial and error to gauge participants' comfort levels and adjust the training accordingly. Practical Tips for Conducting In Situ Simulation Integration into Daily Routine: Conduct simulations around handover times, usually at 8 AM. This timing ensures double staffing, and if handover finishes early, the simulation can proceed without disrupting the department's workflow. Multi-professional Participation: Involving nurses, healthcare support workers, radiographers, and other relevant staff enhances the realism and effectiveness of the simulation. For example, if a scenario involves a CT scan, we physically take the mannequin to the CT scanner. Patient and Staff Engagement: Inform patients and staff beforehand to gain their support. Most patients are understanding and even find it interesting when they know a training exercise is happening. Handling Distractions: Real-world distractions are an integral part of emergency medicine. Incorporating these into simulations teaches teams how to manage interruptions effectively. Securing Buy-in from Your Department Gaining support from senior clinicians and nursing leaders is vital. At St. Emlyn's, our clinical director and senior nurses championed the initiative. Presenting simulation as a solution to improve patient care and team coordination, backed by incident reports and data, helps persuade colleagues of its value. Frequency and Topics for Simulation We aim to conduct simulations three to four times a week. The focus is often on resuscitation and emergency scenarios, but we also cover other essential skills and processes, such as handover communication and teamwork. Keeping scenarios simple and relevant to daily practice ensures that training remains practical and impactful. The Role of Debriefing Debriefing is a critical component of sim