From the Department of Anesthesia, Critical Care and Pain Medicine (L.Z., M.J.C., N.L., S.O., M.N., A.H., R.J.P., J.D.M., S.K.R.), Beth Israel Deaconess Medical Center (J.R.K.); and Department of Anesthesia (R.J.P., J.D.M., S.K.R.), Harvard Medical School, Boston, MA.
Simul Healthc. 2023 Apr 1;18(2):90-99. doi: 10.1097/SIH.0000000000000635. Epub 2022 Feb 10.
Routine workflows were redesigned during the first surge of the COVID-19 pandemic to standardize perioperative management of patients and minimize the risk of viral exposure and transmission to staff members. Just-in-time (JIT), in situ simulation training was adopted to implement urgent change, the value of which in a public health crisis has not previously been explored.
Implementation of workflow changes in the setting of the COVID-19 pandemic was accomplished through JIT, in situ simulation training, delivered over a period of 3 weeks to participants from anesthesia, nursing, and surgery, within our healthcare network. The perceived value of this training method was assessed using a postsimulation training survey, composed of Likert scale assessments and free-text responses. The impact on change in practice was assessed by measuring compliance with new COVID-19 workflows for cases of confirmed or suspected COVID-19 managed in the operating room, between March and August 2020.
Postsimulation survey responses collected from 110 of 428 participants (25.7%) demonstrated significant positive shifts along the Likert scale on perceived knowledge of new workflow processes, comfort in adopting them in practice and probability that training would have an impact on future practice (all P s < 0.001). Free-text responses reflected appreciation for the training being timely, hands-on, and interprofessional. Compliance with new COVID workflows protocols in practice was 95% (121 of 127 cases) and was associated with lower than expected healthcare worker test positive rates (<1%) within the network during this same period.
These findings support JIT, in situ simulation training as a preparedness measure for the perioperative care of COVID-19 patients and demonstrate the value of this approach during public health crises.
在 COVID-19 大流行的第一波期间，对常规工作流程进行了重新设计，以规范患者围手术期管理并最大程度降低病毒暴露和传播给工作人员的风险。即时（JIT）现场模拟培训被采用来实施紧急变革，而在公共卫生危机中，这种方法的价值以前尚未得到探索。
在 COVID-19 大流行期间，通过 JIT 现场模拟培训，在 3 周的时间内，对来自麻醉、护理和外科的参与者实施了工作流程变更。通过模拟培训后调查评估了这种培训方法的价值，该调查由李克特量表评估和自由文本回复组成。通过测量在手术室中管理确诊或疑似 COVID-19 病例时对新 COVID-19 工作流程的遵守情况，评估了对实践变更的影响。
从 428 名参与者中的 110 名（25.7%）收集的模拟培训后调查的回复显示，对新工作流程的认识、在实践中采用这些流程的舒适度以及培训对未来实践的影响的可能性等方面，都存在明显的积极转变（所有 P 值均<0.001）。自由文本回复反映了对培训及时性、实践性和跨专业性质的赞赏。实践中对新 COVID 工作流程协议的遵守率为 95%（127 例中的 121 例），并且在此期间，网络内医护人员的阳性率低于预期（<1%）。
这些发现支持 JIT 现场模拟培训作为 COVID-19 患者围手术期护理的准备措施，并在公共卫生危机期间证明了这种方法的价值。
