A43MAGIC – the management of acute emergencies in GP surgeries using in situ simulation and checklists, project final phase: completed quick reference handbook and plans for sustainability
Authors: Maloney Anne , Shawcross Elizabeth , Harbord Phil , Hill Angus , Higham Helen , Warren Rosemary 
Published: October 2023

Background and aim:

GP teams manage a wide spectrum of acutely unwell and deteriorating patients, these are unexpected, high risk, low frequency events. Ambulance delays mean patients may need prolonged input prior to transfer. There is little best practice guidance for many emergencies seen in primary care. Evidence from secondary care shows improved non-technical skills when checklists are used in emergency simulations.

We have previously presented early phases of the MAGIC project to design a Quick Reference Handbook (QRH) for GP teams and now present the final handbook along with plans for embedding it in primary care.

Activity:

Previous presentations at scientific conferences (ASPiH) covered the Delphi process used to develop the QRH and the pilot training programme incorporating in-situ simulation.

We incorporated feedback from 14 GP teams who used the checklists in the context of in situ simulations and used a round of tabletop simulations at six GP practices to finalize the checklists in the handbook.

The development process was guided by the ‘CLEAR’ principles proposed by Greig et al [1] and the design of the QRH for anaesthetic emergencies [2] which followed human factors principles.

Since completing the GP QRH we have been focusing on plans for sustainability. The QRH will be incorporated into in situ simulation or tabletop exercises [3]. We have written standardized ‘MiniSim’ scenarios using low fidelity techniques and accompanied by the relevant checklist. They will be uploaded on the iRIS platform to ensure ease of access. We are working with colleagues in GP training hubs around the HEE South-East and South-West regions to embed the QRH and then share the work nationally.

Findings:

We have completed a GP QRH including 16 checklists: fourteen to guide clinical actions in acute conditions (Figure 1-A43), one to be used when the diagnosis is unclear, and one to aid non-clinical staff. Additionally, we have included guidance on the use of equipment (e.g. oxygen cylinders and AED) and supporting documents including emergency scoring systems (e.g. NEWS), normal physiological values in children, and a recommended medication and equipment list. These checklists will be made freely available. Feedback on the QRH and in-situ training to date has been universally positive.

An example of a checklist from the GP quick reference handbook

Conclusion:

Checklists improve non-technical skills and team performance in emergency situations. We have developed the world’s first GP QRH to support safer care of emergencies in primary care. The GP QRH will be freely available together with training materials to embed it in practice.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.