BackgroundIn-situ simulation (ISS) has benefits on an organisational level including highlighting patient safety concerns and economical use of resources. For individuals, it negates the need for ...travel to a simulation centre and enhances team working.1 However, stakeholders may feel that in-situ education can distract clinical staff thereby reducing efficiency and patient flow. We responded to this by developing a novel tool of ‘micro’ simulation sessions.Summary of workIn order to create ‘learning in context’ for emergency department (ED) staff, a dynamic team of interprofessional clinical educators developed ‘micro’ ISS. This could be delivered to ED staff without removing them from clinical duty for more than 15 minutes. This allows for rapid education without disruption to departmental flow. Each scenario was adaptable to a multiprofessional team with one-on-one teaching for participants. Scenario flexibility allowed for a balance between debrief, teaching and practical skills. Scenarios were designed in response to near-misses and critical incidents logged via the datix reporting system, responding directly to patient safety concerns.Summary of resultsA package of scenarios was delivered (Management of diabetic emergencies; Phenytoin administration; Trauma/head injury; Sepsis/preparation for transfer; Management of hyperkalaemia; Starting non-invasive ventilation). Key stakeholders from ED, pharmacy, physiotherapy, outreach, intensive care and anaesthetics were involved in the development and delivery of the sessions. 14–25 participants attended every session: a mixture of nurses, doctors (foundation to consultant), health care assistants and students (medical, nursing and physician associates). The interprofessional faculty each taught a diverse group and peer-to-peer learning was encouraged. The scenarios were adaptable to the training needs of the individual. Participants all reported increased confidence levels pre and post-session, their feedback of current learning needs shaped future sessions. Findings from each scenario were collated and a standardised proforma was disseminated to the ED with global learning outcomes and required departmental actions such as equipment orders or change in stock drug concentrations.Discussion and conclusionsOur programme was well received, allowed for departmental training in addition to addressing patient safety concerns. We have shown that ISS does not require large scale scenarios; targeted clinical skills can be addressed in a ‘micro’ session whilst still allowing overall functioning of a busy ED.RecommendationsThis model is easily replicable throughout a hospital setting. Key stakeholder involvement as well as an enthusiastic and adaptable clinical education team ensure well managed and received education.ReferencesSorensen JL, Ostergaard D, LeBlanc V, Ottesen B, Konge L, Dieckmann P, Van der Vleuten C. 2017.Design of simulation-based medical education and advantages and disadvantages of in situ simulation versus off-site simulation. BMC Med Educ. 17:20.
Objective
The study aims to assess whether the increasing use of cardiovascular magnetic resonance imaging in place of diagnostic cardiac catheterization in the management of pediatric patients with ...congenital heart disease has had an impact on pediatric cardiac care.
Design
Retrospective analysis of data was used.
Setting
The study was performed at the Evelina Children's Hospital Cardiology Department.
Patients.
Elective diagnostic cardiac catheterization or magnetic resonance imaging (MRI) from 2005–2010 are included (n = 896).
Outcome Measures
Indication, length of stay, and incidence of complications were recorded. In cases used to plan surgery, 30‐day survival following the procedure was recorded. Surgical outcomes were compared between the two groups. Surgical outcomes planned using MRI were compared with national outcomes from Congenital Cardiac Audit Database.
Results
For catheterizations (50 patients, 31 male, median age 3 years, interquartile range 1 to 12), median hospital stay was 1 day (interquartile range 0 to 3), and complications occurred in 11 (22%). Median hospital stay for MRI (846 patients 517 male, median age 3 years, interquartile range 0 to 9) was significantly shorter: 0 days (interquartile range 0 to 1, P <.001), with fewer complications (16 1.9%, P <.0001). Twenty‐four catheter and 283 MRI patients underwent surgery within 18 months. One catheter patient (2.0%) and four MRI patients (1.4%) died within 30 days (P =.48).
Conclusion
Replacing catheterization with cardiovascular magnetic resonance imaging has resulted in reduced rates of complication and shorter hospital stays without a significant impact on surgical outcome.
PDF
