Chan Albert Kam Ming, Rudolph Jenny W, Lau Vivian Nga Man, Wong Henry Man Kin, Wong Rosinni Si Ling, Lo Thomas S F, Choi Gordon Y S, Joynt Gavin Matthew
Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, New Territories, Hong Kong.
Center for Medical Simulation, Cambridge, Massachusetts, USA.
BMJ Simul Technol Enhanc Learn. 2020 Aug 21;7(4):199-206. doi: 10.1136/bmjstel-2020-000635. eCollection 2021.
In the face of a rapidly advancing pandemic with uncertain pathophysiology, pop-up healthcare units, ad hoc teams and unpredictable personal protective equipment supply, it is difficult for healthcare institutions and front-line teams to invent and test robust and safe clinical care pathways for patients and clinicians. Conventional simulation-based education was not designed for the time-pressured and emergent needs of readiness in a pandemic. We used 'rapid cycle system improvement' to create a psychologically safe learning oasis in the midst of a pandemic. This oasis provided a context to build staff technical and teamwork capacity and improve clinical workflows simultaneously.
At the Department of Anaesthesia and Intensive Care in Prince of Wales Hospital, a tertiary institution, in situ simulations were carried out in the operating theatres and intensive care unit (ICU). The translational simulation design leveraged principles of psychological safety, rapid cycle deliberate practice, direct and vicarious learning to ready over 200 staff with 51 sessions and achieve iterative system improvement all within 7 days. Staff evaluations and system improvements were documented postsimulation.
RESULTS/FINDINGS: Staff in both operating theatres and ICU were significantly more comfortable and confident in managing patients with COVID-19 postsimulation. Teamwork, communication and collective ability to manage infectious cases were enhanced. Key system issues were also identified and improved.
To develop readiness in the rapidly progressing COVID-19 pandemic, we demonstrated that 'rapid cycle system improvement' can efficiently help achieve three intertwined goals: (1) ready staff for new clinical processes, (2) build team competence and confidence and (3) improve workflows and procedures.
面对一场病理生理学尚不确定且迅速蔓延的大流行病，临时医疗单位、临时组建的团队以及难以预测的个人防护装备供应，医疗机构和一线团队很难为患者和临床医生设计并测试出强大且安全的临床护理路径。传统的基于模拟的教育并非为应对大流行病期间时间紧迫的应急准备需求而设计。我们运用“快速循环系统改进”方法，在大流行病期间营造了一个心理安全的学习绿洲。这个绿洲为提升员工技术和团队协作能力以及同时改进临床工作流程提供了环境。
在三级医疗机构威尔士亲王医院的麻醉与重症监护科，在手术室和重症监护病房（ICU）进行了现场模拟。这种转化模拟设计利用心理安全、快速循环刻意练习、直接学习和替代学习的原则，通过51次培训让200多名员工做好准备，并在7天内实现了系统的迭代改进。模拟结束后记录了员工评估和系统改进情况。
结果/发现：手术室和ICU的员工在模拟后对管理新冠肺炎患者明显更加从容和自信。团队协作、沟通以及管理感染病例的集体能力都得到了增强。关键系统问题也被识别并得到了改进。
为在迅速蔓延的新冠肺炎大流行中做好准备，我们证明了“快速循环系统改进”能够有效地帮助实现三个相互交织的目标：（1）让员工为新的临床流程做好准备，（2）培养团队能力和信心，（3）改进工作流程和程序。
