Blaak Marlot Johanna, Fadaak Raad, Davies Jan M, Pinto Nicole, Conly John, Leslie Myles
W21C Research and Innovation Centre, University of Calgary, Calgary, Alberta, Canada.
School of Public Policy, University of Calgary, Calgary, Alberta, Canada.
BMJ Simul Technol Enhanc Learn. 2021 Jul;7(6):487-493. doi: 10.1136/bmjstel-2020-000854. Epub 2021 Apr 13.
The COVID-19 pandemic prompted widescale use of clinical simulations to improve procedures and practices. We outline our deployment of a virtual tabletop simulation (TTS) method in primary care (PC) clinics across Alberta, Canada. We summarise the quality and safety improvements from this method and report end users' perspectives on key elements.
Our virtual TTS used teleconferencing software alongside digital whiteboards to walk clinic stakeholders through patient scenarios. Participants reviewed and rehearsed their workflows and care practices. The goal was for staff to take ownership over gaps and codesigned solutions. After simulation sessions, follow-up interviews were conducted to collect feedback.
These sessions helped PC staff identify and codesign solutions for clinical hazards and threats. These included the flow of patients through clinics, communications, redesignation of physical spaces, and adaptation of guidance for cleaning and personal protective equipment use. End users reported sessions provided neutral spaces to discuss practice changes and built confidence in delivering safe care during the pandemic.
TTS has not been extensively deployed to improve clinical practice in outpatient environments. We show how virtual TTS can bridge gaps between knowledge and practice by offering a guided space to rehearse clinical changes. We show that virtual TTS can be used in multiple contexts to help identify hazards, improve safety and build confidence in professional teams adapting to rapid changes in both policies and practices. While our sessions were conducted in Alberta, our results suggest this method may be deployed in other contexts, including low-resource settings.
新冠疫情促使临床模拟被广泛应用以改进诊疗程序和实践。我们概述了在加拿大艾伯塔省的基层医疗诊所中虚拟桌面模拟（TTS）方法的应用情况。我们总结了该方法带来的质量和安全改进，并报告了终端用户对关键要素的看法。
我们的虚拟TTS使用电话会议软件和数字白板，让诊所相关人员了解患者情况。参与者回顾并演练了他们的工作流程和护理实践。目标是让工作人员自主发现差距并共同设计解决方案。模拟课程结束后，进行了后续访谈以收集反馈。
这些课程帮助基层医疗工作人员识别并共同设计应对临床危害和威胁的解决方案。这些包括患者在诊所内的流动、沟通、物理空间的重新划分，以及清洁和个人防护装备使用指南的调整。终端用户报告称，这些课程提供了中立的空间来讨论实践变革，并增强了在疫情期间提供安全护理的信心。
TTS尚未广泛应用于改善门诊环境中的临床实践。我们展示了虚拟TTS如何通过提供一个演练临床变革的引导空间来弥合知识与实践之间的差距。我们表明，虚拟TTS可用于多种情境，以帮助识别危害、提高安全性，并增强专业团队应对政策和实践快速变化的信心。虽然我们的课程是在艾伯塔省进行的，但我们的结果表明，这种方法可能适用于其他情境，包括资源匮乏地区。
