P1 The impact of unannounced paediatric in situ simulation in an emergency department of a district general hospital

Introduction This project aims to Demonstrate the effectiveness of unannounced Paediatrics in situ simulation to increase knowledge of rare paediatric cases, identify patient safety issues and reinforce teamwork training in a paediatric emergency department (ED) especially with the current shortage of paediatric trained staff in ED. To evaluate feasibility and the perception of learning and stress especially when unannounced in situ simulation, has been described as stressful and stress can adversely affect learning. Methods Unannounced simulation was limited to 15 minutes with 30–45 minutes of debrief within the emergency department. The participants were nurses, students, healthcare assistance and doctors working in ED. To minimise disruption to service delivery, the simulation sessions were held early in the morning at 08.30am to 09.30am. The primary outcome measured using questionnaires was to compare the impact of an announced verse unannounced simulation on stress and learning. Also to address patient safety concerns highlighted by Care quality commission (CQC), cases were selected from major incidence or near misses in the department. Results 100% of the participants reported that their stress level increased as it was an unplanned simulation but 100% of these participants also recorded that they preferred in situ unannounced simulation to an announced simulation. A strong theme that emerged from the feedback was reflected in this participant’s statement…..’In AE we don’t often know what is coming through our doors so we need more unannounced simulations as it presents like real life’.95% reported that they gained useful learning in the unannounced simulation even though it was stressful. Conclusion In situ simulation is a practical method to reinforce team training behaviours, improve staff knowledge and skills thereby improving patient care. Embedding in situ unannounced simulation as a routine expectation in a high risk clinical setting has shown to be a valuable asset to test clinical systems, improve patient safety and overall patient experience.It was observed from the feedback that though unannounced simulation increased participant’s stress level on the day but that didn’t impact on their learning. Infact they preferred it to a planned or announced simulation as it made simulation experience feel ‘real’ with little or no opportunity to self-select into the simulation or decline participation. Recommendation It would have been more beneficial to involve a multidisciplinary team of anaesthetic and Paediatric team in the emergency department in situ simulation training as this gives a more realistic perspective. References In situ simulation: detection of safety threats and teamwork training in a high risk emergency department. BMJ Qual Saf2013 Jun; 22(6):468–77. doi: 10.1136/bmjqs-2012-000942.Epub 2012 Dec 20. Freud D., Andersen, Svane C., et al.(2019)Unannounced vs announced in situ simulation of emergency teams: Feasibility and staff perception of stress and learning. International journal of anaesthesiology, pain and critical emergency medicine. https://doi.org/10.1111/aas.13321