Lakissian Zavi, Sabouneh Rami, Zeineddine Rida, Fayad Joe, Banat Rim, Sharara-Chami Rana
Dar Al-Wafaa Simulation in Medicine (DAWSIM), American University of Beirut Medical Center, Beirut, Lebanon.
Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, P.O. Box 11-0236 Riad El Solh, Beirut, 110 72020 Lebanon.
Adv Simul (Lond). 2020 Jul 29;5:15. doi: 10.1186/s41077-020-00137-x. eCollection 2020.
COVID-19 has taken the world by surprise; even the most sophisticated healthcare systems have been unable to cope with the volume of patients and lack of resources. Yet the gradual spread of the virus in Lebanon has allowed healthcare facilities critical time to prepare. Simulation is the most practical avenue not only for preparing the staff but also for troubleshooting system's latent safety threats (LSTs) and for understanding these challenges via Hollnagel's safety I-II approaches.
This is a quality improvement initiative: daily in situ simulations were conducted across various departments at the American University of Beirut Medical Center (AUBMC), a tertiary medical care center in Beirut, Lebanon. These simulations took place in the hospital with native multidisciplinary teams of 3-5 members followed by debriefing with good judgment using the modified PEARLS (Promoting Excellence and Reflective Learning in Simulation) for systems integration. All participants completed the simulation effectiveness tool (SET-M) to assess the simulation. Debriefings were analyzed qualitatively for content based on the Safety Model and LST identification, and the SET-Ms were analyzed quantitatively.
Twenty-two simulations have been conducted with 131 participants. SET-M results showed that the majority (78-87%) strongly agreed to the effectiveness of the intervention. We were able to glean several clinical and human factor safety I-II components and LSTs such as overall lack of preparedness and awareness of donning/doffing of personal protective equipment (PPE), delayed response time, lack of experience in rapid sequence intubation, inability to timely and effectively assign roles, and lack of situational awareness. On the other hand, teams quickly recognized the patient's clinical status and often communicated effectively.
This intervention allowed us to detect previously unrecognized LSTs, prepare our personnel, and offer crucial practical hands-on experience for an unprecedented healthcare crisis.
新型冠状病毒肺炎（COVID-19）令世界猝不及防；即便最先进的医疗体系也难以应对患者数量众多和资源匮乏的状况。然而，该病毒在黎巴嫩的逐渐传播让医疗机构有了关键的准备时间。模拟不仅是培训工作人员的最实用途径，也是排查系统潜在安全威胁（LSTs）以及通过霍尔纳格尔的安全I-II方法理解这些挑战的最实用途径。
这是一项质量改进举措：在黎巴嫩贝鲁特的一家三级医疗中心——贝鲁特美国大学医疗中心（AUBMC）的各个科室，每天进行现场模拟。这些模拟在医院内进行，由3至5名成员组成的多学科本地团队参与，随后使用经修改的PEARLS（促进模拟中的卓越与反思性学习）进行系统整合的明智复盘。所有参与者都完成了模拟效果工具（SET-M）以评估模拟情况。基于安全模型和LST识别对复盘内容进行定性分析，对SET-M进行定量分析。
共进行了22次模拟，131名参与者参与。SET-M结果显示，大多数人（78%-87%）强烈认同干预措施的有效性。我们能够收集到若干临床和人为因素安全I-II组成部分以及LSTs，比如总体准备不足、对个人防护装备（PPE）穿脱的认知不足、反应时间延迟、快速顺序插管经验欠缺、无法及时有效地分配角色以及缺乏情景意识。另一方面，团队能够迅速识别患者的临床状况，且常常能有效沟通。
这项干预措施使我们能够发现此前未被识别的LSTs，让我们的人员做好准备，并为一场前所未有的医疗危机提供了至关重要的实际操作经验。
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