Simulation Training: Q&A with the Experts

Sharing knowledge to scale learnings and improve patient safety drives HIROC’s work.

So, when we heard about the success of the recent Code Orange simulation from our friends at IWK Health in Nova Scotia, we wanted to learn more about it.

“It’s the first time since 2018 that IWK has run a disaster simulation of this size and scope, and notably, it was the first to involve all levels of staff, from frontline care providers to the CEO and Board of Directors, as well as many departments across the organization. This marks a major milestone in strengthening our collective preparedness and response capabilities.” – excerpt from IWK’s story

Thank you to the team at IWK Health for sharing this story with us!

Sharing your stories and knowledge is one way we can scale learnings across the country. Reach out to us at [email protected] if you have one for us to spotlight.

And thank you to the directors of this simulation exercise, Dr. Vered Gazit, Medical Director, Emergency Preparedness; and Phil Porter, Emergency Preparedness Consultant, for taking time to chat with us. Below you’ll find their top takeaways from this simulation, the importance of emergency preparedness, and advice for running a similar simulation.

Are there one or two top takeaways you learned doing this exercise?

Communication is always a top contender in any debrief of a real or simulated event. Sometimes those communication pathways can be telephone or radio based, but in this case, I’d like to single out our decision to use different colored vests to indicate the wearer’s primary job function, including physicians, nurses, respiratory therapists, diagnostic imaging, pharmacy, and others.

As you can appreciate, many of these folks work every day in their own areas of the hospital and do not know all the other clinical and support folks when they are in a different area, working with different people than they are used to. The exercise provided an excellent opportunity to network and get to know the folks we only interact with via telephone more personally. It was a great team-building exercise.

Another takeaway was that the exercise succeeded because of the many folks that “leaned in” and worked on developing the scenarios over and above their normal duties. We were also encouraged by the number of members of the IWK Board of Directors and senior leadership who took part.

The learning? Without the support of leadership, including underwriting the costs and providing resources (human and other), the exercise would not have been the success it was. It’s good to have both mentors and sponsors at a high level within the organization who provide guidance and support.

Finally, many exercises are planned for the emergency department but don’t include the rest of the hospital at the same level. This exercise was designed to also test Diagnostic Imaging, Pharmacy, our special care units, and operative and peri-operative spaces.

Our departmental plans related to a Code Orange (mass casualty event) are being refreshed, so this exercise also allowed us to capture the individual processes, communications, and decision-making processes.

What advice do you have for other organizations planning a similar exercise of their own?

• Start early in the planning process. Make sure you include people who can provide expertise in their own areas and ensure that the scenario and patient descriptors are as “real” as possible. Schedule the planning meetings well in advance to increase the chances that all participants will be able to join; we found virtual meetings were easier for those who worked shifts.
• Organizational support is critical. An experienced administrative assistant is key to juggling priorities, including procuring equipment and consumables, tracking the over 300 volunteers from our staff and community, and ordering enough food and drinks for participants for the six-hour exercise.

• Advertise the simulation exercise to staff. Dr. Gazit worked very hard to make sure that physicians could claim their participation as part of their continuing medical education (CME) requirements (through Dalhousie University). We also had posters asking folks to volunteer.

  One thing we didn’t do so well this time (which we will fix in the future) is involving the local news media as players in the exercise. This allows them to experience the controlled chaos in the moment and, more importantly, write a human-interest story and publicize the exercise so our community knows we are doing our best to always do our best, no matter the situation.

• You can’t have enough phone lines or participants in the Simulation Cell, especially if you want to keep all the scenario injects going in on time and have ‘players’ available to answer queries and requests.

• In situ simulation is much more effective than any disaster simulation in a simulated hospital. There are ways to minimize the impact on regular patient care, such as scheduling the exercise on a weekend when the ambulatory clinics, operating room, and other services don't operate.

  This also increases your space capacity (as you would in a real disaster) and frees up a lot of people from all units to help out either as health care providers caring for the simulated patients or those behind the scenes running the simulation. Running the disaster exercise in situ, in the real space with the real equipment and staff, truly allows you to test your plans, identify gaps, and combine education with quality improvement work.

• Recruiting and preparing pediatric simulated patients is possible. We often recruit children of staff as well as those from organizations in the community (schools, scouts, theater clubs, etc.). We talk to them and their parents in advance to explain their roles and learn their comfort levels to match the specific role accordingly. Whenever possible we will recruit both the parents and their children.

  We ask them to come early the day of the exercise to have their makeup done; while waiting they can interact with the manikins, ask questions, watch how the moulage is applied, and review their “script” with a coach.

  Young children under age 12 should be escorted by family members who will also become simulated patients or by designated "shadows" who follow them ensuring their wellbeing and safety throughout the exercise.

• Recruiting staff is key. It’s important to have leadership support and ensure employees are paid for their time participating in the exercise. For self-employed physicians we successfully applied for CME.

Why is emergency preparedness planning important for healthcare organizations?

IWK Health prides itself on providing excellence in patient care. Emergency preparedness is just a part of providing that excellence in care.

Without regular exercises, we deprive staff of that reactionary knowledge they need when faced with the patients, families and others who will come to the emergency department when a mass casualty incident occurs.

Not having a plan is still a plan, and we can have all the plans in the world, but the time to read the plan is not when an emergency is occurring. Training, tool talks and tabletop exercises are all part of being prepared, but only a realistic exercise can truly test the processes and procedures that are needed when a real emergency occurs.

What are the benefits of including all levels of staff, including the frontline to senior leadership, in these simulations?

All levels of the organization reap the benefits of an exercise. From a procedural perspective, we vet our processes and identify any gaps that need to be closed, and we update and refresh our plans based on the learnings from exercises. From a budgetary perspective, senior leadership becomes more aware of the level of support required to run a successful emergency preparedness program.

I cannot over-emphasize the importance of our board members being involved, both as members of the exercise emergency operations centre and doing walkabouts to see triage, the Family Information Support Centre, and all our psychosocial response plans. It’s only when people walk to the various areas involved in the exercise that they get a true picture of the number of people involved and the level of coordination required, not just for an exercise, but, more importantly, in a real event.

How did external partners contribute to this simulation?

We involved Emergency Health Services (Ground and Air) in our planning processes and were pleased to welcome two units and a number of paramedics that participated in the actual exercise.

In the future, we will consider trying to design exercises that allow paramedics to more realistically follow their own scope of practice for field triage.

IWK Health was also pleased that the Halifax Regional Board of Education supported our exercise by allowing us to recruit school aged actors to be patients, family members, and others during our exercise.
 

We love hearing about your innovations and sharing stories such as this to help scale learnings across our Subscriber community. If your organization has a story, reach out to us at [email protected].