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Disaster Preparedness in the Emergency Department Using In Situ Simulation
Abstract
High influxes of patients during disasters have led to increased incidence of medical errors in emergency departments (EDs), ultimately leading to poor patient outcomes. Nearly 30% of errors committed in EDs are due to deficiencies in knowledge and skills, and between 60% and 70% of errors occur due in part from communication breakdowns. The goal of this project was to examine whether in situ simulation will increase health care providers' knowledge of how to perform during a disaster, improve competency in skills related to those actions, and to improve communication regarding the special circumstances inherent to a disaster in the ED. A mixed-methods pilot project analyzed the effects of in situ simulation. Results of the project demonstrate that in situ simulation can improve knowledge and communication during a disaster situation.
... FSXs were discussed in seven studies (16,22,25,28,31,32,44), FX in 13 (17)(18)(19)23,26,27,29,30,36,37,45,48,49), LDs in 10 (20,21,24,(33)(34)(35)38,43,47,50) and ETS in six studies (12,(39)(40)(41)(42)46). One study reported results on two separate ETS-type exercises (39) and is reported separately therefore, a total of seven ETS-type exercises were reported on from six studies. ...
... For FX the major purpose was to test preparedness or plans (n=8, 62%) (17,19,23,26,29,30,36,37) and improve exercise design (methodological; n=3, 23%) (27,48,49). The primary purpose of LDs was to improve preparedness (n=7, 70%) (24,33,34,38,43,47,50), followed by testing preparedness or plans (n=3, 30%) (20,21,35). ETS-type exercises were conducted to evaluate/test plans (12,41), test hospital surge capacity (40) and clinical decision making (42). ...
... FSX only included multi-agency exercises (n=4, 57%) (16,25,31,32) and multi-hospital exercises (n=3, 43%) (22,28,44). Organisational scope of FXs and LDs was similar and primarily involved multi-agencies (n=6, 46%) (FX) (17)(18)(19)27,30,45), (n=4, 40%) (LD) (33,43,47,50); and single hospital exercises (n=5, 38%) (FX) (26,29,36,48,49), (n=4, 40%) (LD) (21,24,34,38). ...
... Three mixed methods studies were included in this review were rated as having a high risk of bias [37,38,39]. ...
... Fifteen studies published between 2009 and 2021 were included in the review. Six studies had employed quantitative research methods [25][26][27][28][29][30], six had used qualitative research methods [31][32][33][34][35][36][37] and three had employed a mixed-methods approach [37][38][39]. The studies included in this review had been conducted in ten countries: Japan [25]; China [29,33], Iran [35,37] ...
... Fifteen studies published between 2009 and 2021 were included in the review. Six studies had employed quantitative research methods [25][26][27][28][29][30], six had used qualitative research methods [31][32][33][34][35][36][37] and three had employed a mixed-methods approach [37][38][39]. The studies included in this review had been conducted in ten countries: Japan [25]; China [29,33], Iran [35,37] ...
Following an emergency incident, critically injured patients are often treated by multiple healthcare professionals from Emergency Medical Teams (EMTs) over a short period of time. The process of transportation from the site of an incident to definitive health care therefore depends on coordination and information-sharing which is reliant on the use of Information and Communication Technology (ICT). ICT is essential to ensure the necessary organizational responses to emergency situations by facilitating information-sharing, sustained coordination and collaboration to protect and save the injured. This literature review provides a broad overview which can facilitate an understanding of the experiences between EMTs in emergencies using ICT by systematically finding, reviewing, assessing and synthesizing current evidence. A systematic search guided by PRISMA was performed using relevant electronic databases and manual searches. Studies were limited to original research and only articles published between 2009 and 2021 were included. This review highlights that only a limited number of publications reported ICT use between EMTs in different emergencies in a single study. Fifteen papers were found which reported the experience of coordination and communication using ICT between EMTs in emergency situations in different countries. The findings of these papers indicate that although communication systems during an emergency are crucial, poor quality telecommunications infrastructure affected by difficult weather conditions often led to communication failures between respondents. The majority of these studies highlighted that the use of mobile phones is preferred over other systems due to their multi-functionality. Some of the studies reported issues in coordination between EMTs in which the limited information shared between EMTs affected their preparedness. Furthermore, the review shows that disaster simulation exercises between EMTs are insufficient and require improvement. Future research needs to include the perspectives of emergency operations centre staff along with nurses, physicians and paramedics in a single study to comprehensively explore the EMT response in emergency situations.
... 15,22,23 Setting Simulation has been used in a number of different specialties within medicine, the most common being resuscitation skills. [11][12][13]15,[22][23][24][25][26][27][28] Other specialties included obstetrics and gynecology, midwifery, anesthesiology and mental health. ...
... Simulations on resuscitation were carried out in different settings ranging from the emergency department, ward trauma rooms, outpatient settings, Intensive care units, and operating rooms. 11,13,18,22,24,25,27 The emergency departments ranged from low, medium to high volume departments. 16,23,25 Some studies scheduled the simulations in the morning, due to the decreased number of patients who attend ED at that time. ...
... General adult studies focused on cardiac arrests, airway management, interpreting vital signs and hemorrhage control. 11,18,24,29 However, the majority of studies were specific to pediatric emergencies. Some of these focused on skills such as drawing blood, placing nasogastric tubes, urinary catheters and IV lines. ...
In situ simulation is the practice of using simulated scenarios in a clinical environment itself rather than in training facilities to promote learning and improved clinical care. The use of in situ simulation has been increasingly used to train healthcare staff in dealing with emergencies, resuscitation and clinical skills. The aim of this study is to provide an overview of the themes, perspectives and approaches to in situ simulation for educational purposes with healthcare staff. The literature search included studies describing and evaluating in situ simulations with an educational component. We carried out a narrative synthesis and extracted data on the clinical setting, the simulation purpose, design, evaluation method and impact. In situ simulation has proved useful in a range of different specialties for skills improvement and team development. Simulation design ranges in terms of fidelity, duration and topic. No specific design has shown to be the most efficient. However, adopting a design that fits into the specific centers resources, educational needs and clinical demands is the most important consideration.
... "In Situ" simulations, delivered to real-life frontline personnel in their actual clinical working environment, bring a realism to mass casualty exercises and improve educational outcomes compared to didactic instruction. 9 Furthermore, there is an inherent congruence between simulation and exercise design. Simulation center faculty and staff along with emergency management practitioners have much in common and can work well together bringing the exercise to life. ...
... For complex incidents, the Ottawa Hospital uses the IMS, which is used across the Province of Ontario to ensure expedited interagency coordination. 9 Within the organization, the TOH has adopted this approach, which is used at the senior leadership level (emergency operations center) down through to the unit level, which is termed the unit command post. ...
Providing care in a twenty-first century urban emergency department (ED) and trauma center is a complex high-pressure practice environment. The pressure is intensified during patient surge scenarios commonly seen during mass casualty incidents, such that response must be practiced regularly. Beyond clinical mastery of individual patient trauma care, a coordinated system-level response is essential to optimize patient care during these relatively infrequent events. This paper highlights the need to perform exercises in hospitals while providing practical advice on how to utilize in situ simulation for mass casualty testing. Eleven lessons are presented to assist other emergency management professionals, hospital administrators, or clinical staff to achieve success with in situ simulation. Based upon our experience designing and executing an in situ mass casualty simulation within an ED, we offer lessons applicable to any type of disaster exercise. Simulation offers a powerful tool for the conduct of disaster preparedness exercises for staff across multiple hospital departments and professions.
... 22,23 When simulation scenarios such as drills, are scheduled, nurse managers should grant staff nurses the time to attend such drills, or find ways to cover nurses at the wards if they are working. 24,25 In other methods, nurse educators can also implement simulation scenarios to include patients, families, and other hospital personnel, as if there really was an occurring disaster. 26 After all, when disasters happen, the effects are wide in scale and do not discriminate against hospital departments, patient types, locations, or time of the day. ...
Objective:This study aims to identify the Jordanian nurses’ perception of their disaster preparedness and core competencies.
Methods:A descriptive, cross-sectional research design was used. The data was collected via an online self-reported questionnaire using the disaster preparedness evaluation tool and the core disaster competencies tool.
Results:A total of 126 nurses participated in the study. Jordanian nurses had moderate to high levels of core disaster competencies and moderate levels of disaster preparedness. Core disaster competencies and disaster preparedness levels differed based on previous training on disaster preparedness and the availability of an established emergency plan in their hospitals. Lastly, a previous training on disaster preparedness and core disaster competencies were statistically significant predictors of disaster preparedness among Jordanian nurses.
Conclusions:Organizational factors and environmental contexts play a role in the development of such capabilities. Future research should focus on understanding the barriers and facilitators of developing core disaster competencies and disaster preparedness among nurses.
... As an educational technique, simulation helps to identify skills that need to be improved by giving students the opportunity to develop and practice various skills in a safe environment and in a repetitive manner (Gaba, 2004). In the last decade, clinical simulation has been used for training non-technical skills, such as communication (Kirkpatrick et al., 2017), specifically through standardised patient simulation (Bodine & Miller, 2017;Jung et al., 2016). ...
Aims:
The objectives were to evaluate the effectiveness of a standardised patient simulation programme and to analyse to what extent the students transferred the skills covered in the simulation to clinical practice 6 months after the intervention.
Design:
A quasi-experimental study was carried out, with measurements taken pre-, post- and 6 months after the implementation of a standardised patient simulation programme in a single group.
Methods:
Eligible to participate were all final year nursing undergraduates during the 2020-2021 academic year. In total, 41 undergraduate nursing students took part in all stages of the study. It was measured attitude towards communication, self-efficacy, communication skills and resilience. The degree to which communication skills were used in the real setting was also assessed.
Results:
The students' scores for self-efficacy and perceived communication skills improved and were maintained after six months. Regarding to resilience, improvement was even evident six months following the intervention. In terms of the transfer to clinical practice, the students were making moderate to high use of the communication skills learned in the simulation.
... On the other hand, communication was recognized as a recurrent medical response problem during five disasters in the Netherlands [26]. To reduce errors and enhance patient care during disasters, understanding the principles of communication during a disaster with internal and external partners is fundamental [27,28]. ...
... Abu-Sultaneh et al. 96 Amiel et al. 28 Armstrong et al. 97 Auerbach et al. 38 Barker et al. 98 Bayouth et al. 99 Bredmose et al. 35 Campbell et al. 100 Coggins et al. 101 Farah et al. 102 Generoso et al. 103 Jörgens et al. 104 Jung et al. 105 Katznelson et al. 106 Lakissian et al. 73 Miller et al. 107 O'Leary et al. 87 Patterson et al. 65 Petrosoniak et al. 30 Pirie et al. 108 Qian 109 et al Saqe-Rockoff et al. 110 Truta et al. 111 Wong et al. 74 Zern et al. 77 Zimmermann et al. 70 Walsh et al. 68 Continued on August 3, 2022 by guest. Protected by copyright. ...
Objectives
To provide an overview of the available evidence regarding the safety of in situ simulation (ISS) in the emergency department (ED).
Design
Scoping review.
Methods
Original articles published before March 2021 were included if they investigated the use of ISS in the field of emergency medicine.
Information sources
MEDLINE, EMBASE, Cochrane and Web of Science.
Results
A total of 4077 records were identified by our search strategy and 2476 abstracts were screened. One hundred and thirty full articles were reviewed and 81 full articles were included. Only 33 studies (40%) assessed safety-related issues, among which 11 chose a safety-related primary outcome. Latent safety threats (LSTs) assessment was conducted in 24 studies (30%) and the cancellation rate was described in 9 studies (11%). The possible negative impact of ISS on real ED patients was assessed in two studies (2.5%), through a questionnaire and not through patient outcomes.
Conclusion
Most studies use ISS for systems-based or education-based applications. Patient safety during ISS is often evaluated in the context of identifying or mitigating LSTs and rarely on the potential impact and risks to patients simultaneously receiving care in the ED. Our scoping review identified knowledge gaps related to the safe conduct of ISS in the ED, which may warrant further investigation.
... Previous studies have also found that communication training was mainly focused on training related to particular devices. Homier et al., (2018) and Jung et al., (2016) assessed the use of some communication systems between nurses, physicians and paramedics such as radio, manual phone trees and the use of social media platforms such as WhatsApp and SMS. Although these studies highlighted which systems were preferred, they did not suggest ways of improving communication skills. ...
There is a lack of knowledge regarding communication and information exchange between the emergency medical teams (EMTs) during emergencies, particularly in the Riyadh region of the Kingdom of Saudi Arabia (KSA). The aim of this study is to explore EMTs’ experiences of communication and information exchange during difficult emergency situations in the city of Riyadh.
A qualitative exploratory study was undertaken to explore the experiences of 62 respondents from the Saudi Red Crescent Authority (SRCA) and emergency departments (EDs): a total of 18 were SRCA staff (three call takers, four dispatchers, three field supervisors and eight paramedics), and a total of 44 from hospital EDs, comprising 19 ED nurse managers, 12 ED physician consultants and 13 ED paramedics. Semi-structured interviews were held with the participants, who all had the experience of responding to emergencies and had the authority to communicate with one another. The interviews were tape-recorded and transcribed verbatim and the transcripts were analysed using Braun and Clarke’s thematic analysis [1]. NVIVO 11 was used to aid data management.
Three themes were identified comprising central factors that influence coordination and communication between the participants. These themes were (1) the emotional impact on SRCA staff performance, (2) the effectiveness of the emergency response, and (3) perceptions of emergencies preparation. The first theme highlighted important factors related to emotional and well-being, which impact the performance of the SRCA operation centre staff and have an impact on the information shared with other relevant staff. In the second theme, issues that emerged that related to the effectiveness of the emergency response, coordination and communication between the EMTs were highlighted to be limited in effectiveness. Although several communication systems were used, some of them were not formally sanctioned and some were technical issues related to the systems used. The third theme explored participants’ perceptions of emergencies preparation, and again the findings demonstrated limited evidence of disaster management training or preparation particularly between EMTs. The training in communication among EMTs staff in preparing for disasters was similarly found to have deficits and could be improved. Finally, the findings from this study demonstrated that the level of debriefing that was put in place following an incident could be substantially improved.
Communication between EMTs not only involves the use of advanced technology but also requires improvements in coordinated communication within and between EMTs in relation to an effective response to emergencies and disasters. This could be achieved if the directors, managers and policymakers appreciated more fully the importance of the factors to be considered in relation to the effective use of ICT, the adverse impact of the ineffective use of communications systems, and how the coordination of services could be improved during emergency situations.
... 16 These errors occur more frequently during crises and emergencies. 17 However, with the use of the PTT application, our recent findings during the COVID-19 outbreak indicate that various aspects of communication have improved, which include the efforts needed to communicate, improved access to other medical and nonmedical HCWs, and improved responses to notifications. Since patient transfer to the isolation area would take approximately 3-5 minutes, the notified nurses and physicians would have enough time to get prepared and wear PPE. ...
Objective
To assess the effects of using a smartphone-based push-to-talk (PTT) application on communication, safety, and clinical performance of emergency department (ED) workers during the COVID-19 outbreak.
Design
An observational, cross-sectional study.
Setting
ED in an academic medical center.
Participants
All ED staff members, including physicians (consultants, specialists, residents, and interns), nurses, emergency medical services staff, technicians (X-ray), and administration employees.
Interventions
Eligible participants (n=128) were invited to fill out an online questionnaire 30 days after using a PTT application for sharing instant voice messages during the COVID-19 outbreak.
Main Outcome Measures
Self-reported data related to communication, implementation of personal protective measures, and clinical performance at the ED were collected and analyzed on a 5-item Likert scale (from 5 [strongly agree] to 1 [strongly disagree]). Also, the proportions of favorable responses (agree or strongly agree) were calculated.
Results
Responses of 119 participants (51.3% females, 58.8% nurses, and 34.5% physicians; 90.4% received at least one notification per day) were analyzed. The participants had favorable responses regarding all domains of communication (between 63.0% and 81.5%), taking precautionary infection control measures (between 49.6% and 79.0%), and performance (between 55.5% and 72.3%). Receiving fake and annoying alerts and application breakdowns were the lowest perceived limitations (between 12.5% and 21.0%).
Conclusion
The assessed PTT application can be generalized to other departments and hospitals dealing with patients with COVID-19 to optimize staff safety and institutional preparedness.
... 12,13 They help improve knowledge and communication during a sudden influx of patients in the emergency department, allowing for the entire department to be better prepared for disaster scenarios. 14 ...
Members of an emergency department (ED) staff need to be prepared for mass casualty incidents (MCIs) at all times. Didactic sessions, drills, and functional exercises have shown to be effective, but it is challenging to find time and resources for appropriate training. We conducted brief, task-specific drills (deemed “disaster huddles”) in a pediatric ED (PED) to examine if such an approach could be an alternative or supplement to traditional MCI training paradigms. Over the course of the study, we observed an improving trend in the overall score for administrative disaster preparedness. Disaster huddles may be an effective way to improve administrative disaster preparedness in the PED. Low-effort, low-time commitment education could be an attractive way for further disaster preparedness efforts. Further studies are indicated to show a potential impact on lasting behavior and patient outcomes.
... 5 Simulation training has been routinely used in medicine to train students and residents in emergency management and surgical techniques and is an important component of patient safety and quality of care. [6][7][8][9][10][11] Studies have reported clinical improvement through simulation training in areas such as laparoscopic surgery, anesthesia, and advanced cardiac life support. [12][13][14] Improvements in medical and clinical knowledge, communication, and teamwork are additional benefits of simulation training. ...
Dentists can encounter life-threatening medical emergencies during the provision of routine dental care and must therefore be comfortable with the management of these emergencies. High-fidelity simulation has been used routinely in medical and surgical training and is a recognized and effective educational and assessment tool. The aim of this study was to develop and evaluate a new high-fidelity simulation training course in medical emergency management for residents in the General Practice Residency program at New York Presbyterian/Weill Cornell Medicine. In academic years 2014-16, first-year GPR residents were required to take a simulation course covering medical emergency scenarios that are commonly encountered in the dental office. The course involved a team approach to emergency management with active participation by faculty and residents and with each training session followed by feedback and a formal review of the emergencies covered. Evaluation was achieved through completion of questionnaires by the residents following each session. A total of 14 residents (seven in each year) participated, completing 78 questionnaires in the two-year period. They gave the course an overall rating of 4.91 on a scale from 1 to 5, indicating strong agreement with the utility of the course as a learning tool in medical emergency management training. This course is now fully integrated into the GPR educational program at this institution and is a successful component of the emergency medicine curriculum.
Introduction: The Novel Integrated Toolkit for Enhanced Pre-Hospital Life Support and Triage in Challenging and Large Emergencies (NIGHTINGALE) project was awarded to a consortium to design an innovative toolkit featuring different technological solutions for prehospital mass casualty incident (MCI) response. Translational science (T) methodology was undertaken to develop evidence-based guidelines for MCI response.
Method: The consortium was divided into three work groups (WGs) MCI Triage, Prehospital Life Support and Damage Control and Prehospital Processes. Each WG previously collected data through the project T1 scoping review stage to provide the foundation for the initial T2 modified Delphi draft statements to present to WG internal focus groups for content and NIGHTINGALE study objectives. Their refined statements proceeded to WG specific external focus groups for further editing to be clear and concise for the following modified Delphi consensus rounds. Final WG statements were presented to modified Delphi experts for their consensus using the STAT59 platform with instruction to rank each statement on a seven-point linear numeric scale, where 1 = disagree and 7 = agree. Consensus amongst experts was defined as a standard deviation ≤1.0.
Results: After three modified Delphi rounds, 18 of 24 statements attained consensus by the MCI Triage experts, eight of 25 by the Prehospital and Life Support and Damage Control experts, and 23 of 28 by the Prehospital Processes experts.
Conclusion: The three work groups will utilize consensus statements during the NIGHTINGALE project T3 phase to create evidence-based MCI response guidelines.
Background:
A Mass Casualty Incident response (MCI) full scale exercise (FSEx) assures MCI first responder (FR) competencies. Simulation and serious gaming platforms (Simulation) have been considered to achieve and maintain FR competencies. The translational science (TS) T0 question was asked: how can FRs achieve similar MCI competencies as a FSEx through the use of MCI simulation exercises?
Methods:
T1 stage (Scoping Review): PRISMA-ScR was conducted to develop statements for the T2 stage modified Delphi (mD) study. 1320 reference titles and abstracts were reviewed with 215 full articles progressing for full review leading to 97 undergoing data extraction.T2 stage (mD study): Selected experts were presented with 27 statements derived from T1 data with instruction to rank each statement on a 7-point linear numeric scale, where 1 = disagree and 7 = agree. Consensus amongst experts was defined as a standard deviation ≤ 1.0.
Results:
After 3 mD rounds, 19 statements attained consensus and 8 did not attain consensus.
Conclusions:
MCI simulation exercises can be developed to achieve similar competencies as FSEx by incorporating the 19 statements that attained consensus through the TS stages of a scoping review (T1) and mD study (T2), and continuing to T3 implementation, and then T4 evaluation stages.
Mass casualty events (MCE) strain available health-care resources requiring extraordinary measures. Simulated exercises are used to improve preparedness. We sought to identify learning points and common themes arising from such exercises in literature. Reporting of action points to improve response plans were investigated. Type of exercises, environments, and departments were also explored. We systematically searched 3 databases and applied our eligibility criteria. Inclusion criteria were in-situ MCE simulations of clinical response to traumatic MCEs, including scene management, prehospital care, and in hospital care. Exclusion criteria were nonmedical response, infectious outbreaks, training courses with self-selecting participants, simulations assessing mechanical tools, and mathematical modeling. A total of 6883 titles were identified and screened. Eighty-three studies were read in full. Twenty-two articles were included. We identified numerous learning points, which were collated and categorized into 11 themes. Fifty-nine percent of the papers reported actions that would be or had been implemented. MCE simulation exercises have been found to improve familiarity and confidence among participants. The 11 themes identified from published exercises overlap with areas of improvement from real events. MCE simulations in the literature appear to focus on carrying out the exercise itself rather than learning points possibly missing opportunities to improve response plans.
Background
In-Situ Simulation (ISS) enables teams to rehearse and review practice in the clinical environment to facilitate knowledge transition, reflection and safe learning. There is increasing use of ISS in healthcare organisations for which patient safety and quality improvement are key drivers. However, the effectiveness of ISS interventions has not yet been fully demonstrated and requires further study to maximise impact. Cohesive programmatic implementation is lacking and efforts to standardise ISS terms and concepts, strengthen the evidence base and develop an integrated model of learning is required. The aim of this study was to explore the current evidence, theories and concepts associated with ISS across all areas of healthcare and develop a conceptual model to inform future ISS research and best practice guidance.
Methods
A scoping review was undertaken with stakeholder feedback to develop a conceptual model for ISS. Medline, OpenGrey and Web of Science were searched in September 2018 and updated in December 2020. Data from the included scoping review studies were analysed descriptively and organised into categories based on the different motivations, concepts and theoretical approaches for ISS. Categories and concepts were further refined through accessing stakeholder feedback.
Results
Thirty-eight papers were included in the scoping review. Papers reported the development and evaluation of ISS interventions. Stakeholder groups highlighted situations where ISS could be suitable to improve care and outcomes and identified contextual and practical factors for implementation. A conceptual model of ISS was developed which was organised into four themes: 1. To understand and explore why systematic events occur in complex settings; 2.To design and test new clinical spaces, equipment, information technologies and procedures; 3. To practice and develop capability in individual and team performance; 4. To assess competency in complex clinical settings.
Conclusions
ISS presents a promising approach to improve individual and team capabilities and system performance and address the ‘practice-theory gap’. However, there are limitations associated with ISS such as the impact on the clinical setting and service provision, the reliance of having an open learning culture and availability of relevant expertise. ISS should be introduced with due consideration of the specific objectives and learning needs it is proposed to address. Effectiveness of ISS has not yet been established and further research is required to evaluate and disseminate the findings of ISS interventions.
Objective
The objective was to describe a feasible, multidisciplinary pediatric mass casualty event (MCE) simulation format that was less than 2 h within emergency department space and equipment constraints.
Methods
This was a prospective cohort study of an MCE in situ simulation program from June-October 2019. Participants rotated through 3 modules: (1) triage, (2) caring for a critical patient in an MCE setting, and (3) being in a disaster leadership role. Triage accuracy, knowledge, self-evaluation of preparedness, and MCE skills by means of pre- and post-test surveys were measured. Wilcoxon matched pairs signed rank test scores and McNemar’s matched pair chi-squared test were performed to evaluate for statistically significant differences.
Results
Forty-six physicians (MD), 1 physician’s assistant (PA), and 22 nurses participated over 4 simulation d. Among the MD/PA group, there was a statistically significant 7% knowledge increase (95% confidence interval [CI], 3%-11%). Nurses did not show a statistically significant knowledge difference (0.04, 95% CI, 0.04%, 14%). There was a statistically significant increase in triage and resource use preparedness ( P < 0.01) for all participants.
Conclusion
This efficient, feasible model for a multidisciplinary ED disaster drill provides a multi-modular exposure while improving both MD and PA knowledge and all staff preparedness for MCE.
Objective:
To develop and evaluate a disaster nursing preparedness training program to improve nursing students' ability in disaster fundamentals, triage, and family preparedness when facing a disaster.
Design and sample:
An experimental study was applied using a pretest and post-test control group design. Participants were randomly assigned to the experimental (n = 31) and control (n = 32) groups.
Measures:
The program lasted 7 hr. All participants completed structured questionnaires at three time points. Results were compared between the two groups using Mann-Whitney U tests. Outcome measures were knowledge, skill, and attitude.
Results:
Students receiving the program displayed greater increases in knowledge and skills related to disaster preparedness than those in the control group. One month after the intervention, the experimental group still had significantly higher levels of disaster knowledge and skill than the control group. There were no statistically significant differences over time in attitude measures.
Conclusions:
This program enhanced students' ability and the findings can serve as a basis for further developing public health education for all nurses. Chinese leaders of public health institutions and nursing administrators can create guidelines for PHN competencies and prepare the public health nursing workforce to be effective in disaster, preparedness, response, and recovery.
In many countries, procedural sedation outside of the operating room is performed by pediatricians. We examined if in situ sedation simulation training (SST) of pediatricians improves the performance of tasks related to patient safety during sedation in the Emergency Department (ED). We performed a single-center, quasi-experimental, study evaluating the performance of sedation, before-and-after SST. Sixteen pediatricians were evaluated during sedation as part of their usual practice, using the previously validated Sedation-Performance-Score (SPS). This tool evaluates physician behaviors during sedation that are conducive to safe patient outcomes. Following the sedation, providers completed SST, followed by a structured debriefing. They were then re-evaluated with the SPS during a subsequent patient sedation in the ED. Using multivariate regression, odds ratios were calculated for each SPS component, and were compared before and after the SST. Thirty-two sedations were performed, 16 before and 16 after SST. SPS scores improved from a median of 4 (IQR 2–5) to 6 (IQR 4–7) following SST (p < 0.0009, median difference 2, 95% CI 1–3). SST was associated with improved performance in four SPS components. The findings of this pilot study suggest that sedation simulation training of pediatricians improves several tasks related to patient safety during sedation.
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)-accredited hospitals must conduct disaster drills twice a year, with one incorporating a mass casualty incident to the emergency department (ED). The authors found no studies describing the potential negative impact on the quality of care real patients in the ED receive during these drills. The objective was to determine the impact that mass casualty drills have on the timeliness of care for nondisaster patients in a pediatric ED.
Since 2001, nine disaster drills involving mass casualties to the ED were conducted at the authors' institution. The authors studied 5-, 10-, and 24-hour blocks of time surrounding these events and defined quality measures as the timeliness of care in terms of length of stay (LOS) in ED, time-to-triage, and time-to-physician. Drill dates were compared with control dates (the same weekday on the following week). Paired t-tests were used to compare outcomes of interest between drill and control days.
Nine drill days and nine control days were studied. There was no statistically significant difference between drill dates and control dates in average time-to-triage and time-to-emergency physician and average ED LOS. Admitted patients spent less time in the ED during drill dates.
Disaster drills at this institution do not appear to significantly affect the timeliness of care to nondisaster drill ED patients. Attention should be paid to the quality of care "real" patients receive to ensure that their care is not jeopardized during an artificial stress to the system during a disaster drill.
Objective:
Hierarchy, the unavoidable authority gradients that exist within and between clinical disciplines, can lead to significant patient harm in high-risk situations if not mitigated. High-fidelity simulation is a powerful means of addressing this issue in a reproducible manner, but participant psychological safety must be assured. Our institution experienced a hierarchy-related medication error that we subsequently addressed using simulation. The purpose of this article is to discuss the implementation and outcome of these simulations.
Methods:
Script and simulation flowcharts were developed to replicate the case. Each session included the use of faculty misdirection to precipitate the error. Care was taken to assure psychological safety via carefully conducted briefing and debriefing periods. Case outcomes were assessed using the validated Team Performance During Simulated Crises Instrument. Gap analysis was used to quantify team self-insight. Session content was analyzed via video review.
Results:
Five sessions were conducted (3 in the pediatric intensive care unit and 2 in the Pediatric Emergency Department). The team was unsuccessful at addressing the error in 4 (80%) of 5 cases. Trends toward lower communication scores (3.4/5 vs 2.3/5), as well as poor team self-assessment of communicative ability, were noted in unsuccessful sessions. Learners had a positive impression of the case.
Conclusions:
Simulation is a useful means to replicate hierarchy error in an educational environment. This methodology was viewed positively by learner teams, suggesting that psychological safety was maintained. Teams that did not address the error successfully may have impaired self-assessment ability in the communication skill domain.
Introduction A substantial barrier to improving disaster preparedness in Australia is a lack of prescriptive national guidelines based on individual hospital capabilities. A recent literature review revealed that only one Australian hospital has published data regarding its current preparedness level.
To establish baseline levels of disaster knowledge, preparedness, and willingness to respond to a disaster among one hospital's staff, and thus enable the implementation of national disaster preparedness guidelines based on realistic capabilities of individual hospitals.
An anonymous questionnaire was distributed to individuals and departments that play key roles in the hospital's external disaster response. Questions concerned prior education and experience specific to disasters, general preparedness knowledge, perceived preparedness of themselves and their department, and willingness to respond to a disaster from a conventional and/or chemical, biological, or radiological incident.
Responses were received from 140 individuals representing nine hospital departments. Eighty-three participants (59.3%) had previously received disaster education; 53 (37.9%) had attended a disaster simulation drill, and 18 (12.9%) had responded to an actual disaster. The average disaster preparedness knowledge score was 3.57 out of 10. The majority of respondents rated themselves as "not really" prepared and were "unsure" of their respective departments' level of preparedness. Most respondents indicated a willingness to participate in both a conventional incident involving burns and/or physical trauma, and an incident involving chemical, biological or radiological (CBR) weapons.
Australian hospital staff are under-prepared to respond to a disaster because of a lack of education, insufficient simulation exercises, and limited disaster experience. The absence of specific national standards and guidelines through which individual hospitals can develop their capabilities further compounds the poverty in preparedness. Corrigan E , Samrasinghe I . Disaster preparedness in an Australian urban trauma center: staff knowledge and perceptions. Prehosp Disaster Med. 2012;27(5):1-7.
The Joint Commission requires hospitals to implement 2 disaster drills per year to test the response phase of their emergency management plans. Despite this requirement, there is no direct evidence that such drills improve disaster response. Furthermore, there is no generally accepted, validated tool to evaluate hospital performance during disaster drills. We characterize the internal and interrater reliability of a hospital disaster drill performance evaluation tool developed by the Johns Hopkins University Evidence-based Practice Center, under contract from the Agency for Healthcare Research and Quality (AHRQ).
We evaluated the reliability of the Johns Hopkins/AHRQ drill performance evaluation tool by applying it to multiple hospitals in Los Angeles County, CA, participating in the November 2005 California statewide disaster drill. Thirty-two fourth-year medical student observers were deployed to specific zones (incident command, triage, treatment, and decontamination) in participating hospitals. Each observer completed common tool items, as well as tool items specific to their hospital zone. Two hundred items from the tool were dichotomously coded as indicating better versus poorer preparedness. An unweighted "raw performance" score was calculated by summing these dichotomous indicators. To quantify internal reliability, we calculated the Kuder-Richardson interitem consistency coefficient, and to assess interrater reliability, we computed the kappa coefficient for each of the 11 pairs of observers who were deployed within the same hospital and zone.
Of 17 invited hospitals, 6 agreed to participate. The raw performance scores for the 94 common items ranged from 18 (19%) to 63 (67%) across hospitals and zones. The raw performance scores of zone-specific items ranged from 14 of 45 (31%) to 30 of 45 (67%) in the incident command zone, from 2 of 17 (12%) to 15 of 17 (88%) in the triage zone, from 19 of 26 (73%) to 22 of 26 (85%) in the treatment zone, and from 2 of 18 (11%) to 10 of 18 (56%) in the decontamination zone. The Kuder-Richardson internal reliability, by zone, ranged from 0.72 (95% confidence interval [CI] 0.58 to 0.87) in the treatment zone to 0.97 (95% CI 0.95 to 0.99) in the incident command zone. The interrater reliability ranged, across hospital zones, from 0.24 (95% CI 0.09 to 0.38) to 0.72 (95% CI 0.63 to 0.81) for the 11 pairs of observers.
We found a high degree of internal reliability in the AHRQ instrument's items, suggesting the underlying construct of hospital preparedness is valid. Conversely, we found substantial variability in interrater reliability, suggesting that the instrument needs revision or substantial user training, as well as verification of interrater reliability in a particular setting before use.