O21 In-situ simulation to facilitate transition to a new emergency department facility in ghana

BackgroundKorle Bu Teaching Hospital is a large tertiary care and national referral centre in Accra, Ghana. The Emergency Department is currently split into: surgical and medical emergencies, trauma, and gynaecology units. These units will merge into a single Emergency Department in a new purpose-built venue. This project used low-fidelity in-situ simulation to orient clinical staff prior to transition.AimsThe aims were to: (a) familiarise the doctors, nurses and pharmacists with the new facility layout, monitoring and resuscitation equipment (b) identify/troubleshoot workflow problems prior to transition (c) provide life support training to staff (d) improve inter-disciplinary teamwork.MethodologyA four-session programme on handover and advanced life support skills was developed. The final session was an in-situ simulation in the new department that ran six times with different multi-disciplinary groups. Each session comprised two scenarios in which a critical patient (a CPR manikin) went into cardiac arrest shortly after arrival. Debriefing after each scenario focused on what went well and opportunities for improvement.OutcomesOpportunities for improvement centred on three main themes: knowledge gaps, non-technical skills, and systems issues. A majority of time during debrief in all sessions was spent addressing knowledge gaps and teamwork skills in the use of life support protocols and the new equipment. Teaching style was varied from hands-off facilitator to background supervision, based on variations in the level of participants’ knowledge. Team performance on the second scenario uniformly improved. All participants requested further departmental teaching on cardiac arrest scenarios and expressed plans for personal study. Debrief also identified systems issues such as a need for new departmental guidelines and workflow protocols prior to relocation to the new facility. For example, participants discussed where to store and how to access resuscitation medications/supplies, and how best to staff, co-locate patients, and handover between different functional areas.ConclusionsIt has been suggested that error may be necessary to facilitate the learning process. This low-fidelity, immersive scenario allowed staff to practice life support skills and familiarise themselves with a new clinical environment without risk of harm to patients. Debrief of errors in this safe situation stimulated participants’ drive to learn. The simulations also supported the planni