Introduction:

University Hospitals Dorset (UHD) relocated maternity services into a newly constructed building. Transformational simulation is an effective method for identifying safety threats and driving healthcare improvements [1]. Research is limited on transformative simulation for maternity relocations. This project aimed to use simulation to identify latent safety threats in a new maternity unit and explore the impact on staff.

Introduction:

In February 2025 Newcastle Hospitals Trust ran a multi-disciplinary, multi-stage simulated exercise demonstrating care for a patient with a viral haemorrhagic fever (VHF). The exercise, entitled ‘Moulin Rouge’, followed on from work at the Royal Free Hospital, London (Exercise ‘Mamma Mia’), which conducted an exercise using a Trexler-based method of isolation and care in 2024 [1]. The Infectious Diseases (ID) team at Newcastle simulated a PPE-based care model to explore the relative challenges and benefits compared against the Trexler model.

Supporting Documents – Figure 1-A108

Figure 1:

Evaluation from observers stating whether the objectives of the exercise had been met.

Introduction:

Simulation plays a crucial role in healthcare by providing a controlled and risk-free environment for training, education, quality improvement, innovation and research. Funding is often required to support the resources needed including; faculty, equipment and/or technology, venues, scenarios and administrative support, amongst others to develop, establish and sustain the delivery of simulation activity. There is a need to clearly articulate the requirements, benefits and cost effectiveness of simulation to justify and secure investment. Additionally, there is a need to foster organisational ownership and buy in to help sustain simulation. Yet funding for this type of learning activity is finite and understanding and justifying costs can be challenging [1].

Introduction:

Provision of safe perioperative care in remote theatre locations has many challenges. NAP 4 identified airway management in remote sites is associated with increased risk of morbidity and mortality [1]. Simulation training can aid preparedness to manage infrequent but highly critical events. Simulation training is often recommended following a critical events [2]. Insitu Simulation (ISS) undertaken in a clinical team’s own workplace provides a safe learning environment, improves team work and performance and identifies latent safety threats [3]. We organised ISS training in our dental DPU for the clinical team after review of learning needs and following recommendations from a critical event.

Introduction:

Patient safety is a cornerstone of healthcare, and this principle extends to simulated patients/participants (SPs) who contribute to healthcare education. Ensuring their well-being is an ethical obligation that requires careful consideration of recruitment, role allocation, emotional impact, and ongoing support [1]. This innovation explores an ethical framework, produced with SPs, that prioritises their safety and well-being while maintaining the integrity of the educational event. Originally conceived in 2016 [2], this framework has since been refined, with multiple supportive tools, to enhance its effectiveness and applicability.

Supporting Documents – Figure 1-A105

Introduction:

When opening a new healthcare space, simulation based clinical systems testing allows for potential patient safety threats to be identified [1]. Translational simulation can be used in this context due to the focus on improving patient care and healthcare systems through diagnosing safety and performance issues and delivering simulation-based intervention [2].

The creation of a new paediatric day surgery centre required an interdisciplinary simulation programme designed to familiarise staff with the new environment and equipment, test systems and processes, and enhance team working both within and between departments. Clinical scenarios added focus on human factors and non-technical skills alongside strategies for improvement [3].

Introduction:

Following funding from the Morgan Advanced Studies Institute (MASI) a pilot study was conducted with expertise from the SUSIM Simulation and Immersive Learning Centre at Swansea University.

Healthcare professionals often lack the training and confidence to communicate effectively with d/Deaf patients, leading to miscommunication, reduced trust, and poorer health outcomes. Traditional simulation-based education (SBE) programmes rarely reflect the lived experiences of d/Deaf individuals or include British Sign Language (BSL) and deaf culture [1,2]. This project aimed to address this gap through the co-creation of immersive Virtual Reality (VR) learning modules with the d/Deaf community. The research question was: How can immersive simulation technologies be co-designed with the d/ Deaf community to enhance student understanding and inclusive communication in healthcare?

Supporting Documents – Table 1-A103

Table 1.

Data from Deaf club focus group.

Lack of healthcare staff awareness about interpreter provision	Poor communication	Stereotypes of deaf people	Impact of poor health staff Deaf awareness	Discrimination (specific acts)	Positive suggestions to improve care for Deaf patients
Wi-Fi is a big issue when using remote interpreters	Call name? reception call name, assume not present	Assuming I won’t complain or answer back	Being a patient (in-patient), very lonely and isolating	Refusal to wear a clear mask. Told me to ‘watch my behaviour’	Ask patient what works well for them
Assumption of not needing an interpreter without clarification or communication	I prefer to have it all written down, but their handwriting is terrible and not as detailed	Assumption – when you can talk	Lip reading is hard, when you are ill it’s worse	Interpreter being asked to wait outside as too many people in the room	Male interpreter for male patients, female for female especially if treatment is sensitive
No clue about how to book interpreter	If they shout room number, then I don’t know		Patients feel that staff can revert to shouting, banging, poking instead of the medical notes being clear that the patient is Deaf and seeking an interpreter	Issues of informed consent	Need a screen with name and room number and estimated wait times

Introduction:

A sense of belonging within the National Health Service (NHS) workforce is imperative in establishing a safe and effective working environment, as outlined in the NHS People Plan (2020) [1], ‘The NHS must welcome all, with a culture of belonging and trust. We must understand, encourage and celebrate diversity in all its forms’ (p.24). It can be challenging to establish a sense of belonging within the NHS where large teams are working under high pressures in inconsistent shift patterns. Incorporating lived experiences, a simulation workshop was designed to enhance participants’ knowledge and understanding of how to foster workplace belonging when interacting with colleagues with protected characteristics.

Introduction:

Workplace incivility is a pervasive issue in healthcare, negatively impacting staff well-being, teamworking, cognitive load and patient safety [1]. Traditional training may not capture specific human factor or patient safety elements related to incivility. This project aims to evaluate the effectiveness of an innovative, multidisciplinary simulation-based intervention designed to increase awareness of incivility and its impact on patient safety within the NICU.

Introduction:

A quality improvement (QI) project using in-situ simulation (ISS) was undertaken at a Cardiac catheterisation laboratory (CCL) in a London teaching hospital. The CCL provides 24-hour primary percutaneous coronary intervention (PPCI) for patients having a heart attack and is a lifesaving treatment. Cardiac arrest can happen during the procedure as a heart attack complication.

Guidance released in 2021 [1] advocates early use of a mechanical cardiopulmonary resuscitation (M-CPR) device after the first cycle of CPR meaning PPCI can continue as it is safe to deliver fluoroscopy, which may facilitate treatment intervention for the potential cardiac arrest reversible cause. A baseline audit showed this was not happening.

Introduction:

The provision of major trauma resuscitation in the emergency department (ED) is a life-saving, time-critical multidisciplinary (MDT) process that is susceptible to latent safety threats (LSTs). Testing the system response using simulation can yield valuable lessons for improving patient safety [1]. No ‘blueprint’ currently exists to guide planning and delivery of this quality improvement (QI) process within NHS acute EDs that form part of major trauma networks (MTNs). This project aimed to develop and pilot a replicable strategy for delivering in-situ simulation to test and improve trauma resuscitation systems.

Introduction:

The introduction of the Patient Safety Incident Response Framework (PSIRF) marked a shift in how patient safety incidents are reviewed. Although external training opportunities are available, staff feedback highlighted a need for more practical understanding of PSIRF and human factors. To address this, we developed a bespoke, financially sustainable course, enabling staff to engage interactively with the changes in PSIRF. A key focus was on preparing staff to carry out swarm huddles, as the new learning response with the most local ownership.

Introduction:

Opioid analgesia remains a key pharmacological option for the management of post-operative pain [1]. Preventing and recognising adverse events associated with opioid analgesia is vital, due to the risk of life-threatening sedation and respiratory depression. Nurses play an important role in the recognition and initial management of these patients.

Simulation-based education (SBE) has been shown to have a significant positive effect as a training strategy for nurses [2]. Here, we aim to determine whether SBE, delivered in a ward environment, can increase nurses’ knowledge and confidence in managing patients with opioid toxicity with respiratory compromise.

Supporting Documents – Table 1-A97

Table 1.

Table of results. (* p<0.05 = statistical significance)

	Number of responses	Mean (range)	Standard deviation	z-value (compared to before)	p-value* (compared to before)
1) Knowledge
Before	7	3.57 (3–5)	0.787	---	---
After	7	4.57 (4–5)	0.535	2.377	0.0174
Follow-up	6	4.17 (4–5)	0.408	2.236	0.0253
2) Recognition
Before	7	3.57 (2–4)	0.787	---	---
After	7	4.71 (4–5)	0.488	2.53	0.0114
Follow-up	6	4.16 (3–5)	0.753	1.41	0.1585
3) Airway management
Before	7	3.71 (2–5)	0.951	---	---
After	7	4.71 (4–5)	0.488	2.377	0.0174
Follow-up	6	4.33 (4–5)	0.516	1.964	0.0495
4) Management
Before	7	3.71 (2–5)	0.951	---	---
After	7	4.42 (3–5)	0.787	1.673	0.0944
Follow-up	6	4.50 (4–5)	0.548	2.169	0.0301
5) Naloxone
Before	7	3.86 (1–5)	1.345	---	---
After	7	4.86 (4–5)	0.378	1.976	0.0482
Follow-up	6	4.83 (4–5)	0.408	1.732	0.0833

Introduction:

Analysis of patient safety incidents and complaints is an essential form of learning for healthcare institutions, with harm to patients having major human, moral, ethical and financial implications¹. In response to common and repeated incidents, weekly in-situ simulation-based education has been implemented on the Older Persons’ Medicine (OPM) ward to enhance learning amongst the multidisciplinary team. The team included Doctors, Nurses, Healthcare Assistants and Advanced Nurse Practitioners.

Supporting Documents – Table 1-A96

Location	Participants	Feedback
Both wards on older persons’ medicine.	90% Nursing, Health Care Nursing, and Doctors.	“I feel that having the training on the actual ward where I work was very beneficial as it added to the atmosphere of trying to work in a busy clinical environment.”“Really good session as difficult to access some training due to ward pressures. Also the session being catered to our specialty is better for staff to increase their knowledge and skill set”“Do more!”

Introduction:

Cardiac arrests, though rare in District General Hospitals (DGHs), require effective team performance. Studies show that each minute of delay in delivering the first shock during out-of-hospital ventricular fibrillation cardiac arrest decreases the probability of survival to discharge by 6% [1].

During our monthly in-situ simulation program, we identified a potential delay to shock delivery with delayed connection of defibrillator pads. Using the SEIPS framework [2] we aimed to explore both equipment and workflow inefficiencies.

Supporting Documents – Figure 1-A95

Introduction:

Managing anticoagulation in emergencies requires swift decisions, collaboration, and precision. Despite existing guidelines, real-world practice often suffers from delays and inconsistencies. This Quality Improvement Project (QIP) at the Royal Victoria Hospital (RVH) used in situ simulation combined with a novel debriefing model integrating, Figure 1:

•Scottish Debrief Model – for emotional processing and team reflection.

•SEIPS framework – to analyse system-level safety factors.

•i-SOG – to highlight gaps between intended and actual workflows.

This structured debriefing enabled identification of performance and system issues while aligning with the four Meta-Debriefing pillars:

1. Theory-based – rooted in established models.

2. Psychologically safe – fostering open discussion.

3. Context-dependent – focusing on ED-specific anticoagulation challenges.

4. Formative – driving practical improvements and learning.

Supporting Documents – Figure 1-A94

As a collaborative quality improvement project between the Acute General Medicine team (AGM) and the Resuscitation Service, the REsuS project’s primary aim is to enhance resuscitation team leadership skills, alongside developing non-technical skills throughout the responding multi-disciplinary team (MDT).

Initiated in response to a qualitative evaluation of leadership and team dynamics during 2222 calls across the Trust. Informed by Anderson et al.‘s [1] 2021 paper on ‘Best practices for educating and training resuscitation teams for in-hospital cardiac arrest’, the program aligns with themes identified for improving resuscitation management, such as promoting training engagement, clear communication, and responsive leadership.

Methods:

Unanticipated, ‘real-time’ simulations were conducted in 2 acute medical units. The scenarios comprised of a peri-arrest assessment to full cardiopulmonary arrest, prompting emergency-alarm activation and Registrar-led Advanced Life Support response. The ‘in-situ’ and ‘without prior-warning’ approach, integral to this initiative, elicits a genuine response to a medical emergency, utilising the clinical environment, available equipment, and actual clinical staff. Facilitated by an experienced Resuscitation Practitioner and a Critical Care Registrar, using Cooper et al.’s Team Tool©[2], the participants are evaluated for leadership and teamwork. Post-simulation debriefings serve as the pivotal learning phase, highlighting effective practice and areas for improvement in non-technical skills, through feedback and critical self-reflection.

Results:

The ongoing project has a further 8 planned simulations. From the determined power calculation, current projected outcomes aim for a minimum 10% increase in overall Team Tool scores, indicating enhanced leadership and team effectiveness. This current project operates as a pilot study, employing Plan-Do-Study-Act cycles to refine facilitation methods within resource constraints. Concluding by July 2024, documentation of results, the positive impacts, and the challenges, will be highlighted in the presentation.

Discussion:

Engagement with Ward Managers, Consultants, and Service Leads, ensuring pro-active support is vital for the project’s future success. An important component is the proposal of a sustainable version of this leadership programme. Aligning with the NHS’s commitment to continual learning, outlined in the Patient Safety Incident Response Framework [3]. The presentation will highlight the strategies to achieve ongoing sustainability and the proposed integration to the mandatory training pathway for both resuscitation and human factors education.

The REsuS project is a significant undertaking, particularly working within clinical settings with ongoing patient care. Barriers to project implementation include staff availability, time-constraints, and bed-space considerations, exacerbated by the 2023-2024 industrial action. Despite these obstacles, leading this project is highly motivating, with positive feedback and optimistic outcomes.

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.

References

1. Anderson TM, Secrest K, Krein SL, Schildhouse R, Guetterman TC, Harrod M, et al. Best practices for education and training of resuscitation teams for in-hospital cardiac arrest. Circulation: Cardiovascular Quality and Outcomes [Internet]. 2021;14(12). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8759032/.

2. Cooper S, Cant R, Porter J, Sellick K, Somers G, Kinsman L, Nestel D. Rating medical emergency teamwork performance: Development of the Team Emergency Assessment Measure (TEAM). Resuscitation: Simulation and Education [Internet]. 2010;81(4). Available from: https://www.sciencedirect.com/science/article/abs/pii/S0300957209006339?via%3Dihub.

3. NHS England. Patient Safety Incident Response Framework [Internet]. Available from: https://www.england.nhs.uk/patient-safety/patient-safety-insight/incident-response-framework/. [Accessed 5 March 2024].

Health Education England have recently endorsed the use of simulation activity as a crucial mechanism through which new policies and procedures can be tested to identify latent patient safety threats [1].

Our tertiary neonatal intensive care unit (NICU) has, in response to national requirements and recent safety incidents, developed a new Neonatal Major Haemorrhage Protocol (NMHP). This is a complex, dual-site protocol which requires action from staff in multiple departments over both sites. To aid development of the protocol, we utilised simulation to stress test the guideline and to identify gaps in the roll out of its use.

Methods:

We designed a two-part simulation to test the NMHP. The key priorities of these simulations were in Identification and Innovation [2].

1. A ‘Table-Top’ Simulation in which knowledge of staff in each department was tested through simulation of principal phone calls within the NMHP.

2. An In-Situ Simulation of the NMHP within the NICU. This involved five nursing staff, three medical staff and four facilitators.

In lieu of a traditional debrief, participants and facilitators engaged in a modified debrief with the purpose of identifying problems that arose during the simulation and developing action points for improvement of the protocol and reduction in patient safety threats.

Results:

The ‘Table-Top’ Simulation uncovered lack of dissemination of the new protocol to one key department. Following this, education of this team was completed.

The In-Situ Simulation identified 16 primary issues, from which 28 separate action points were developed. The primary issues identified related to equipment, process and educational needs for both nursing and medical staff, as well as inaccuracies and/or omissions within the new written protocol.

The action points developed included amendments to the protocol, need for additional staff training, changes to processes in ordering blood and sending blood samples to a second site and development of a “Neonatal Major Haemorrhage Box” which would provide staff swift access to the protocol, key drug guidelines, key equipment, tabards for role allocation and a newly designed record sheet.

Discussion:

Simulation is a valuable tool in the development of new clinical protocols. Our experience demonstrates that, when utilised effectively, latent patient safety threats not recognised earlier in the protocol development stage, can be identified and minimised.

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.

References

1. Health Education England Technology Enhanced Learning. Enhancing education, clinical practice and staff wellbeing. A national vision for the role of simulation and immersive technologies in health and care [Internet]. 2020. Available from https://www.hee.nhs.uk/sites/default/files/documents/National%20Strategic%20Vision%20of%20Sim%20in%20Health%20and%20Care.pdf. [Accessed 10 April 2024].

2. Weldon SM, Buttery AG, Spearpoint K, Kneebone R. Transformative forms of simulation in health care – the seven simulation-based ‘I’s: a concept taxonomy review of the literature. International Journal of Healthcare Simulation. 2023. Open Access. Available from: https://ijohs.com/article/doi/10.54531/TZFD6375. [Accessed 10 April 2024].

Microcephalic primordial dwarfism is the rarest and most severe form of dwarfism [1]. The associated craniofacial abnormality means patients are difficult to bag mask ventilate and intubate. A patient with primordial dwarfism is transitioning from Alder Hey paediatric hospital to our hospital. The patient requires frequent intubations which were achieved using an asleep, spontaneously breathing fibreoptic technique. This differs vastly from our usual practice in adults. We have developed a standard operating procedure (SOP) for anaesthetising and intubating this patient in our hospital. We are using in situ simulation to test our SOP and improve our system.

Methods:

We provided four x 1-hour high fidelity simulations in our emergency theatre for four different multidisciplinary teams, each comprising six members. We designed a scenario that mirrored the patient’s clinical presentation in an emergency, utilising an interactive paediatric mannequin and an actor as the parent. Each team was required to manage the patient and parent according to the SOP. We noted the behaviours of the teams and how they used the SOP. The simulation was followed by a debrief focusing on human factors.

Results:

Twenty-four candidates participated. Pre-simulation, only 1 candidate (4%) felt confident in using the techniques specified in the new SOP, increasing to 14 candidates (58%) post simulation. We identified the following areas for improvement and have revised the SOP accordingly:

● Make the SOP flowchart role based.

● Modify the SOP to include a “situation report” at 5-minute intervals.

● Make the anaesthetic plan clearer by using headings and coloured highlights.

Discussions in the debrief also identified latent factors in the wider hospital system which we are working to address. These included:

● Would staff on ward areas be skilled enough to recognise an early deterioration in the patient and refer to anaesthetics promptly?

● Would ward areas have adequate paediatric equipment?

● How would an intubation in a non-theatre environment be managed?

Discussion:

In situ simulation has been used to test and improve our SOP and enhance the confidence of our staff. We identified and have started to rectify latent factors within our hospital system. We now plan to:

● Use low-fidelity simulation with a 3D printout of the patient’s head to teach the SOP to the wider team.

● Repeat the high-fidelity simulation to ensure that our system is robust.

● Develop and test an SOP for a non-theatre intubation plan.

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.

References

1. Walking with Giants Foundation. About Microcephalic Primordial Dwarfism [Internet]. Liverpool (UK): Walking with Giants Foundation; 2008 [updated 2019, cited 2024 Apr 21]. Available from: https://www.walkingwithgiants.org/about-mpd/.

In the interprofessional healthcare setting, foundation doctors are expected to to meet mental health competencies outlined in the UK Foundation Training Curriculum 2021 [1]. However, a lack of formal mental health education can lead to diminished confidence and skills in managing patients with acute mental health and physical clinical needs across various clinical settings (e.g. Emergency Department/ED, medical and surgical wards) in doctors and allied healthcare professionals. Recognizing this gap, a simulation-based programme was designed and piloted by foundation doctors, overseen by simulation faculty, to address the needs identified through analysis of cross specialty surveys amongst trainers and learners.

Methods:

The aim of this study was to assess the effectiveness of a one-day learner-designed mental health simulation-based programme for interprofessionals in a tertiary London teaching hospital, featuring four common scenarios. The intended learning outcomes focused on management of acute mental health presentations, risk and safety assessment, application of relevant policies and legislation (e.g., CODE 10 policy, Mental Capacity Act/MCA, Mental Health Act/MHA), and de-escalation techniques. Simulated patient played by professional actors trained in mental health simulation were utilized in scenarios with support from facilitators and technicians, followed by debrief sessions after each scenario. Pre-course and post-course questionnaires, along with verbal feedback, were collected for evaluation.

Results:

Thirteen professionals, comprising 7 doctors and 6 nurses including site nurse practitioner, participated in the programme. Before the course, only 8% of participants had formal mental health training. Only 62% of participants were aware that MHA Section 5(2) cannot be applied in ED. Analysis of pre- and post-course questionnaires revealed a significant increase in confidence levels across various scenarios, such as managing active suicidal ideation (77% uncertain vs. 100% somewhat confident), acute psychosis (92% uncertain vs. 77% somewhat confident), delirium on background of schizophrenia, substance misuse (delirium tremens in acute alcohol withdrawal) and personality disorders (PD), such as borderline PD (BPD). Notably, there was enhanced understanding of CODE 10, de-escalation skills, and application of MHA legislation post-simulation (Figure 1-A33). Participants unanimously found the programme highly useful, citing that high fidelity level was maintained in scenarios with acquisition of soft skills including multi-disciplinary teamwork and prioritization of self-care, psychological and physical safety.

Figure 1-A33.

Discussion:

This study underscores the effectiveness of an interprofessional mental health simulation-based programme designed by learners in bridging the gap in formal mental health education and delivering compassionate, timely and safe mental health care to meet the emerging demand across the NHS.

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.

References

1. Health Education England. UK Foundation Programme Curriculum 2021 [Internet]. UK Foundation Programme NHS. 2021 [cited 2023 Oct 21]. Available from: http://foundationprogramme.nhs.uk/curriculum.

Acknowledgments:

Thank you to simulation faculty, development and technical team, staff from medical and surgical teams, nursing team, senior site nurse manager team, liaison psychiatry team and emergency medicine team who gave invaluable advice on all aspects of the pilot study including scenario design, teaching materials and with running of the pilot simulation programme.

MELISSA (Mobile Educational Learning, Improving Simulation and Safety Activities) is a double decker bus designed to deliver healthcare education and training across the Northeast and North Cumbria [1]. The North East of England is one of the largest geographical areas in terms of a NHS training region. The training region also includes North Cumbria, where NHS workers may face 80-mile (129km) trips to attend training at a main hospital site with clinical education and simulation facilities. The ambition of this innovative project is to deliver clinical training, service delivery or public information campaigns to remote and rural areas. The events supported involve the public, our patients and all members of the NHS workforce.

Methods:

The MELISSA team works in partnership with organisations to support work training and education across all aspects of healthcare. MELISSA can be booked by completion of an event form via the website. The team meet with each partner to discuss the proposed event and how this aligns to either Faculty of Patient Safety objectives, meets a training curriculum need or an NHS strategy [2]. A full-service evaluation is currently being undertaking with an academic partner utilising a ripple effects methodology.

Results:

Since 2020, MELISSA has facilitated 281 events with 23867 delegates on board, 23 clinical training events for example emergency medicine regional teaching and foundation doctors’ teaching/ wellbeing days, facilitated over 500 nursing & midwifery council competence signs offs in rural district hospitals and 41 healthcare careers sessions. MELISSA has worked with Middleborough United Football Club to deliver BLS and AED awareness sessions on match days to football fans and their families. MELISSA has also participated in 118 public awareness sessions and 111 clinical delivery sessions including educational student lead clinics. Recent feedback based on 54 responses from the facilitators who have used the service, utilising a Likert scale of 1-7 (1- very poor, 7 exceptional) showed very positive results with averages greater than 6 in most areas.

Discussion:

MELISSA is a popular resource in the North East and North Cumbria. The service has been used to support postgraduate training in the region for centres that are currently struggling with capacity challenges to accommodate their training demands. Due to increasing requests for the use of MELISSA, The Faculty of Patient Safety launched a second vehicle, MELISSA 2, in June 2023 which provides the fleet with greener credentials, more resilience and more sustainability to the service.

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.

References

1. MELISSA | The NHS Training and Simulation Bus [Internet]. NE Learning Trust. Available from: https://www.melissabus.co.uk/.

2. Faculty of Patient Safety | Home | North East Simulation Network [Internet]. North East Sim. [cited 2024 Apr 27]. Available from: https://www.northeastsimulation.co.uk/about/faculty-of-patient-safety.

The Association for Simulated Practice in Healthcare has identified the importance of resource management in team training to improve clinical performance, to develop culture, and educational governance within a safe and supportive learning environment [1]. Simulation has been successfully used as a quality and risk management resource to test new medical facilities for safer patient care.

Methods:

The scenarios were designed to last for approximately thirty minutes. The debrief was approximately one hour. The in-situ simulations were designed to consider:

● Emergency management within specialities

● Design of the new clinical environment

● Equipment and ergonomics

● Environmental and Human Factors such as transfers, portering, communication, manual handling

The clinical simulations were run over multiple days, these included Major Trauma, Obstetrics and Neonatal, Critically Unwell Adult and Child, Primary Percutaneous Coronary Intervention and a Major Incident scenario. Clinicians and nurses from the Emergency Department (ED), as well as stakeholders attended from Medical specialties, Porters, Chaplaincy, Blood Bank (Biochemist and Nurse), Manual handling, Consultants in Anaesthesia and Intensive Care, Critical Care Lead for Trauma, Neonatal and Obstetrics Doctors, Paediatric speciality Doctors, Lead Resuscitation Officer, Patient Safety Officers, Theatres, Clinical Governance, and Critical Care Lead for Paediatric Critical Care.

Simulations enabled the department to highlight areas where the environment required additional/specialist equipment. After each scenario, a debrief was performed, specifically looking at the non-technical/human factors/equipment issues that arose. Issues were identified with door access, lift usage, signage, transfers and manual handling. The Emergency Department (ED) was not fully operational and therefore not everything could be tested.

Results:

From the simulations key recommendations were made for equipment to be purchased and they highlighted the environmental factors that could impact the day-to-day running of the ED. Pharmacy raised concerns regarding medication availability in the new location and its distance from the main hospital site. The risk associated with the extended transfer routes to the main hospital with the crossing of a link bridge, the lack of lifts with no override key, and lack of signage were highlighted. New standard operation procedures were also recommended. The simulation report was presented to the ED operational team for consideration.

Discussion:

Overall, the simulations provided a safe environment in order to expose potential problems to the ED team prior to opening, this enabled mitigations to be actioned. The simulations also allowed for all staff to immerse themselves within the new environment to allow for familiarisation of the department prior to opening.

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.

References

1. The ASPiH Standards - 2023: guiding simulation-based practice in health and care. ASPIH. 2023. Available from: https://aspih.org.uk.

Performing chest compressions (CC) during cardiorespiratory resuscitation (CPR) can lead to rescuer fatigue, potentially diminishing the quality of CPR. Previous studies [1-3] showed that the physical fitness of the rescuer might affect fatigue levels and CPR effectiveness. This study aims to examine how physical activity levels influence muscle activity and its correlation with the quality of CC.

Methods:

This study is part of an ongoing multicentric pseudo-randomized manikin study, that is being conducted in Portugal, Finland and Germany. Data was collected between May and October 2023. Healthcare professionals (doctors, nurses and paramedics), experienced in CPR, aged between 18 and 65 years-old, were recruited by convenience sample to perform 3 minutes of uninterrupted CC in a Resusci Anne QCPR (Laerdal) simulator, placed on a bed, without mattress. The bed height was adjusted to the rescuer’s knees level.

Socio-demographic data and physical activity levels were collected using a questionnaire, which included the Stanford Brief Activity Survey (SBAS). Electromyogram (EMG) surface electrodes were placed in both triceps brachii to assess the muscle activation levels through the calculation of the root mean square (RMS) value. Participants reported their fatigue timing during the exercise, and perceived exertion was evaluated using the Borg Scale immediately post-trial. CC quality was measured by the depth of compressions recorded by the simulator. EMG and CC depth were sampled every 15-sec and calculated from the mean of 4 consecutive contractions. Approval from the ethical committee was obtained prior the study.

Results:

Twenty-five participants were included, with mean age was 38.6 ± 11.4; 60% were female (n=15) and 52% physically active (n=13). During CPR, sedentary individuals reported fatigue earlier than the active participants (96s vs 180s), although not statistically significant. They also experienced a higher perceived exertion after the trial on the Borg Scale (14 vs 12, p = 0,03). EMG showed a slightly greater recruitment of muscle fibres for sedentary individuals, although not significantly different from active participants. (Figure 1-A30, left). Compression depth in sedentary participants decreased over time, with the mean value dropping to sub-optimal level (< 5cm) after 75 s (Figure 1-A30, right).

Figure 1-A30.

Muscle activity (Left) and chest compressions depth (right) for sedentary and active individuals, during the 3-min uninterrupted chest compression exercise. Boxes present the median self-reported fatigue time.

Discussion:

Physical fitness appears to influence the efficacy of CPR. Active individuals maintained adequate compression depth longer with less muscle activation, suggesting better endurance and technique efficiency. Conversely, sedentary participants experienced quicker fatigue and reduced compression quality, underscoring the importance of physical fitness in performing effective CPR.

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.

References

1. Nayak VR, Babu A, Unnikrishnan R, Babu AS, Krishna HM. Influence of physical activity of the rescuer on chest compression duration and its effects on hemodynamics and fatigue levels of the rescuer: a simulation-based study. Indian Journal of Critical Care Medicine. 2020.

2. López-González A, Sánchez-López M, Garcia-Hermoso A, López-Tendero J, Rabanales-Sotos J, Martínez-Vizcaíno V. Muscular fitness as a mediator of quality cardiopulmonary resuscitation. American Journal of Emergency Medicine. 2016;34:1845–1849.

3. Ock SM, Kim YM, Chung JH, Kim SH. Influence of physical fitness on the performance of 5-minute continuous chest compression. European Journal of Emergency Medicine. 2011;18(5):251–256.

Acknowledgments:

This work was supported by national funds of the FCT – Fundação para a Ciência e a Tecnologia, I.P., under the project “QualityCPR, ref. 2022.03731.PTDC”, and by a grant from the Laerdal Foundation (ref. 2022-0083).

Anaesthetic emergencies, though infrequent, pose a significant threat to patient safety. Simulation-based training offers participants the opportunity to immerse themselves in safe, realistic clinical scenarios, allowing them to hone their skills without risking patient harm. For the educator, the challenge lies in balancing the vast array of emergencies to be taught with limited resources available. We explored whether focusing on transferable skills, specifically human factors, can improve confidence in managing these emergencies.

Methods:

The East and North Hertfordshire Anaesthetic Novice Simulation (ENHANS) course, a one-day program designed for novice anaesthetists, ran five times between April 2023 and March 2024. It covered a range of common and complex anaesthetic emergencies with a focus on human factors. It combined pre-course material with debriefing sessions following each simulated scenario. These debriefings, led by trained facilitators, followed the ‘description, analysis, application’ technique, focusing on understanding what, why, and how actions evolved during the scenario and allowing participants to learn through reflection [1]. We also explored how human factors affected the progress of the scenario.

To assess effectiveness, participants completed pre- and post-course questionnaires using a five-point Likert scale. These questionnaires evaluated confidence in managing various anaesthetic emergencies, including both those directly practiced and those not explicitly covered.

Results:

Forty participants attended the simulation across five sessions. We observed a statistically significant improvement (Wilcoxon Signed-Rank test) in self-reported confidence in managing anaesthetic emergencies (mean pre-course score: 1.9, post-course: 3.9, p <.05). Confidence also improved for practiced scenarios (mean pre-course score 2.1, post-course 4.0, p <.05) and for unpractised scenarios (mean pre-course 2.3, post-course 3.3, p <.05).

Discussion:

Our findings demonstrate a statistically significant improvement in self-reported confidence across all emergency scenarios, including those not directly practiced. This suggests a key strength of the course: its focus on transferable skills. By emphasising human factors, like communication, teamwork, and situational awareness, ENHANS equips participants with a broader framework applicable to diverse emergencies. This aligns with the concept of ‘deliberate practice’, where core skills development fosters greater adaptability in novel situations [2].

The positive outcomes of this study support integrating human factors training into simulation-based education for anaesthetists. This approach offers several advantages. Firstly, it allows for efficient use of limited resources by focusing on transferable skills. Secondly, it equips participants with a broader toolbox applicable to diverse emergencies, potentially enhancing patient safety.

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.

References

1. Eppich W, Cheng A. Promoting excellence and reflective learning in simulation (pearls). Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare. 2015;10(2):106–115.

2. Briese P, Evanson T, Hanson D. Application of Mezirow’s transformative learning theory to simulation in Healthcare Education. Clinical Simulation in Nursing. 2020;48:64–67.

A child becomes the subject of a child protection plan if they are judged to be at continuing risk of harm at an initial child protection conference (ICPC) [1]. During 2023 over 74,000 ICPCs took place, with 50,780 children placed on protection plans [2]. The main aim of this project was to create a realistic simulated ICPC, to enable students to experience what it is like to attend a ICPC as they rarely get to do this in real life due to confidentiality and the sensitivity of the information shared. The project promoted collaboration with multiple different professionals from programmes across the University, including the School of Arts, Media and Creative Technologies, Police, Social Work, Nursing and Allied Health Professions. It has enabled a richer learning experience for all students in the School of Health and Society.

Methods:

The design was developed from an existing case study of a simulated family embedded for teaching and learning in the Social Work degree programme. This case study was adapted to fit into a safeguarding case. Repurposing resources already created for a different programme saved time and reduced duplication of effort. Professionals were invited to participate to take on roles based on the requirements of the scenario. Professionals required prior experience of attending ICPCs. as they were not given a script and acted in role in response to the scenario content and information presented as they would in real-life practice.

Media students were hired from the University consisting of 2 film crew, a director, an editor, and a sound technician.

Results:

The immersive digital content has had a positive impact on the development and promotion of collaborative and interprofessional working. A short trailer of the immersive digital content will be showcased. The simulated ICPC is scheduled to be used for teaching and learning imminently and feedback will be sought from student learners and facilitators.

Discussion:

The benefits of this project have exceeded expectations. Professionals involved in the simulated ICPC were onboard from the start and enthusiastic about the creation of a shared resource, which will be beneficial to all. Having the same goal helped to progress the project. Everyone took their roles seriously and commented on how, during the simulation, they forgot it wasn’t a real case. A positive outcome from this project was the development of future projects and an opportunity to create working partnerships with other programmes that will continue long term.

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.

References

1. Gov.uk. Children in need [Online]. 2023. Available from: https://explore-education-statistics.service.gov.uk/find-statistics/characteristics-of-children-in-need#content.

2. Department for Education. Children in need census [Online]. 2023. [Available from: https://www.gov.uk/guidance/children-in-need-census.

This quality improvement initiative focuses on utilising in-situ simulation techniques to promote active participation from the multidisciplinary healthcare team to improve in-patient falls management. The project focused on a simulated patient that had sustained a fractured neck of Femur after experiencing a fall on the ward. Safe transfer of the fallen patient and identification of equipment needed was central to the project’s objectives. In doing so, learner centred engagement assisted in the identification of organisational and systematic barriers that impinge on best practice.

As in-situ simulation can proactively identify latent system issues that may be acting as barriers in achieving best practice [1], how effective can it be in improving staff management, in response to a fallen in-patient that has sustained a Fractured neck of Femur?

Methods:

A collaborative approach was initiated and fostered to allow key stakeholders to identify fall-related issues and areas most in need of improvement within the Trust relating to falls. Using in-situ simulation, a standardised patient was utilised to recreate a realistic scenario, where a patient falls on the way to the toilet. The standardised patient ‘role plays’ that they have sustained a hip injury which presents as a fractured neck of femur, hence unable to get up from the floor. The multidisciplinary ward team were then observed to see how they collectively managed the fallen patient and how they safely transfer the patient from the floor. A protected, inclusive debrief was then carried out to enhance understanding of the scenario undertaken and to highlight barriers encountered.

Results:

Although the multidisciplinary team appeared to have a good awareness of Trust policy and procedure pertaining to post-fall care, accessibility to essential equipment needed was lacking. A need for staff training in the safe use of this essential equipment was apparent.

Discussion:

By carrying out this immersive in-situ simulation, specific ward issues that required attention were identified, problems that may have gone unnoticed if not presented in a realistic scenario, recreating real-time patient care needs. Therefore, in-situ simulation is an ideal and effective modality in capturing authentic latent issues that may occur during the management of a fallen patient that has sustained a fractured neck of femur. The need for improvements were identified and cascaded to the relevant teams to remove barriers for best 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.

References

1. National Health Service (NHS) Nottingham University Hospitals. In-situ Simulation [Internet]. 2024 [cited 23/02/24]. Available from: https://www.nuh.nhs.uk/insitu-simulation/

Reflective Learning Conversations (RLC) can be used during debriefing to develop competence and clinical reasoning of healthcare practitioners [1, 2]. The current available RLC debriefing models were established to develop general clinical reasoning skills without consideration of the influencing factors concerning different learners’ experiences and competence levels in a multicultural simulation learning environment.2 Ignoring these factors can put learners at risk of cognitive overload, inappropriate engagement in the learning process, and underdeveloped clinical reasoning [2, 3]. To mitigate that risk, a learner-centered RLC debriefing model was co-designed by a working group of simulation experts, educators, and clinical stakeholders. We aim to describe the evaluation of the co-designed RLC debriefing model’s reliability and validity for use in multicultural simulation learning environments in the presence of different learners with different levels of competence and experience.

Methods:

A mixed methods quasi-experimental, pre-test/post-test research design was used to evaluate the RLC debriefing model’s reliability and validity. The study sample consisted of a cohort of critical care nurses and advanced nurse practitioners who attended critical care simulation courses (n=110) between 3 March 2022 and 2 February 2023, and were recruited from nine large tertiary public hospitals in Qatar. Participants (n=110) were pre-assigned to simulation activities as experimental (n=55) and control (n=55) groups. The data were collected from both groups using self-reported questionnaires, three direct observations and video reviews of the participants’ clinical reasoning using CREST and LCJR tools, and focus group interviews. The quantitative data analyses were conducted using Mann-Whitney and Wilcoxon tests, and a thematic analysis for the qualitative data analysis.

Results:

The newly co-designed RLC model was deemed to be valid and reliable to enhance learners’ clinical reasoning skills while attending adult critical care simulation-based courses. The post-test group had a significantly higher level of clinical reasoning compared to the pre-test group, p= [.608, <.001, <.001] z= [-.513, -3.729, -5.850] respectively for three different observations (Table 1-A26). The model demonstrated a Cronbach alpha and ICC of (α=0.968, and ICC=0.972) respectively.

Discussion:

Attending simulation in the presence of different learners’ experiences and competence levels in a multicultural simulation learning environment are important factors in avoiding clinical reasoning under-development and cognitive overload. A learner-centered RLC debriefing model was co-designed and evaluated in consideration of these factors toward clinical reasoning optimisation. The model is deemed valid and reliable to enhance participants’ clinical reasoning for a single discipline (nursing), and future validations are recommended for interprofessional simulation-based education.

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.

References

1. Decker S, Alinier G, Crawford SB, Gordon RM, Jenkins D, Wilson C. Healthcare simulation standards of best practiceTM The debriefing process. Clinical Simulation in Nursing. 2021;58:27–32.

2. Almomani E, Sullivan J, Samuel J, Maabreh A, Pattison N, Alinier G. Assessment of clinical reasoning while attending critical care Postsimulation reflective learning conversation: a scoping review. Dimensions of Critical Care Nursing. 2023;42(2):63–82.

3. Almomani E, Sullivan J, Saadeh O, Mustafa E, Pattison N, Alinier G. Reflective learning conversations model for simulation debriefing: a co-design process and development innovation. BMC Medical Education. 2023;23(1):837.

Table 1-A26.

Descriptive and inferential tests for direct observation and video review using CREST and LCJR

Assessment method	Group	N	Mean Rank	Mann-Whitney U	Wilcoxon W	Z	P-Value
1st direct observation using CREST	Control	55	54.50	1457.500	2997.500	-.513	.608
	Experimental	55	56.50
2nd direct observation using CREST	Control	55	46.00	990.000	2530.000	-3.729	<.001
	Experimental	55	65.00
3rd direct observation using CREST	Control	55	39.69	643.000	2183.000	-5.850	<.001
	Experimental	55	71.31
1st direct observation using LCJR	Control	55	52.63	1354.500	2894.500	-1.242	.214
	Experimental	55	58.37
2nd direct observation using LCJR	Control	55	56.00	1485.000	3025.000	-.201	.841
	Experimental	55	55.00
3rd direct observation using LCJR	Control	55	43.50	852.500	2392.500	-4.735	<.001
	Experimental	55	67.50
1st video review usingCREST	Control	55	54.50	1457.500	2997.500	-.513	.608
	Experimental	55	56.50
2nd video review using CREST	Control	55	41.41	737.500	2277.500	-5.268	<.001
	Experimental	55	69.59
3rd video review usingCREST	Control	55	35.81	429.500	1969.500	-7.223	<.001
	Experimental	55	75.19
1st video review usingLCJR	Control	55	47.40	1067.000	2607.000	-3.038	.002
	Experimental	55	63.60
2nd video review usingLCJR	Control	55	52.08	1324.500	2864.500	-1.296	.195
	Experimental	55	58.92
3rd video review usingLCJR	Control	55	37.27	510.000	2050.000	-6.767	<.001
	Experimental	55	73.73
Total		110

The Mental Health First Aid (MHFA) awareness course typically involves PowerPoint presentations with limited practical skills practice, leaving attendees with insufficient hands-on experience. This gap was identified by recipients of MHFA training, who were lay individuals. Working in collaboration, we aimed to transform the traditional MHFA training by incorporating simulation-based learning, providing attendees with immersive experiences and practical skill development. Considering the simulation-based ‘I’ taxonomy [1], this initiative falls into improvement, (making something that already exists better), involvement (inviting excluded groups to generate new perspectives), and influence (potential to encourage attendees to actualise their skills).

Methods:

We designed a supplementary half-day workshop as a continuation to the half day MHFA awareness course. Simulation-based activities focused on communication frameworks such as MHFA’s ALGEE (Assess, Listen, Give support, Encourage professional support, Encourage other support) [2] and STEPS (Start, Time, Empathy, Provision of support, Sense check) [3]. The development group concluded that focussing on the most common presentations first aiders might encounter, would have optimal benefit to society. Scenarios covered situations within the community when first aiders might be faced with: people with depression, acute anxiety, and post-traumatic stress disorder.

Results:

The incorporation of simulations after MHFA awareness training significantly enhanced participant engagement and skill acquisition. Data from groups before the simulation addition and from groups after the simulation addition, revealed a marked difference in self-assessed levels of confidence in applying ALGEE and STEPS frameworks. Post-workshop evaluations indicated increased understanding of mental health issues and improved readiness to provide support in real-life scenarios. Furthermore, participants expressed appreciation for the immersive learning experience and its applicability to diverse settings.

Discussion:

Our findings underscore the effectiveness of simulation-based learning in augmenting MHFA training outcomes. By providing opportunities for practical application of communication frameworks and exposure to real-world scenarios, simulations facilitated deeper learning and skills practice among attendees. This transformative approach not only enhances the quality of MHFA training but also promotes safety, and has the potential to improve mental health outcomes. Our simulation-based approach to MHFA training offers a replicable and pertinent strategy for organisations seeking to promote mental health literacy. Co-designed with lay attendees, this innovative training methodology ensures that MHFA training remains dynamic, engaging, and impactful in addressing the evolving needs of communities.

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.

References

1. Sharon MW, Buttery A, Spearpoint K, Kneebone R. Transformative forms of simulation in health care – the seven simulation-based ‘I’s: a concept taxonomy review of the literature. International Journal of Healthcare Simulation. 2023.

2. Mental Health First Aid. ALGEE: How MHFA helps you respond in crisis and non-crisis situations[Internet]. Mental Health First Aid. 2021. Available from: https://www.mentalhealthfirstaid.org/2021/04/algee-how-mhfa-helps-you-respond-in-crisis-and-non-crisis-situations/.

3. STEPS Curriculum [Internet]. SimComm Academy. [cited 2024 Apr 28]. Available from: https://simcommacademy.com/services/steps-curriculum/.

We run a busy simulation centre in South London, with increasing demand for courses. We have become proficient at delivering several online courses on the same day, but for in-person courses we are limited by only having one simulation suite. We work with actors as simulated patients to cover mental health topics.

Other centres have tried novel methods to increase participant numbers [1]. We build on our existing practice to do similar.

Methods:

We have iteratively developed the capacity and skills to deliver two courses simultaneously from one sim suite.

By converting office space into a second debrief room, we have duplicated space for participants. This involved adding new connectivity to allow a SMOTS display, as well as creating a suitable learning space.

We have added the same functionality to a third room in our building, so we have the option to run three in-person courses at the same time.

It is important to consider double delivery of the same course separately from parallel delivery of different courses. To deliver the same course to two groups, one simulation technician can easily control the space, and the same actors can portray their characters twice. Parallel deliveries require more planning, so that the scenarios do not clash, and the simulation space displays the correct setting.

Results:

We will use the evaluation data to compare courses run traditionally against those run as double. We have gathered routine data on participant satisfaction. We will be able to compare numerical and free-text responses across the two categories. Anecdotally the participants have had an equally positive experience, and have not noticed the added cognitive load.

The costs have been negligible, by using old but functional equipment and spaces which we already have access to. There is no increase in actor costs.

We encountered logistical challenges in using what was previously only an office as a debrief room. The technician has been controlling the proceedings of the day across both groups, which is a new skillset to develop.

Faculty and technical teams feel a great deal of satisfaction at the end of these days, which bolsters team morale.

Discussion:

Double delivery has been a successful development, provisionally with no evidence of impaired quality. Actor costs will be the same or less, and there is better utilisation of available space. Parallel deliveries allow greater fidelity via a wider variety of actors.

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.

References

1. Lewandowski J, Haynes J, Dores C, Randles D. The double debriefing room: a pilot to challenge the issue of capacity whilst enhancing efficiency. 00:00:00.0 [cited 2024 Apr 30]. Available from: https://www.ijohs.com/article/doi/10.54531/JNNN8327.

Simulation based education (SBE) within undergraduate health care professional courses and secondary care is acknowledged to be an essential component to train individuals and teams to deliver safe and effective patient care [1]. Acceptance of SBE’s role and value within primary care (PC) settings is evolving, but widespread endorsement and recognition of its transformative potential for education and training is lacking [2]. This is despite the long tradition for General Practitioner (GP) training to include working with simulated patients (SPs) to develop consultation skills as a fundamental concept, and the adoption by the Royal College of GPs of the Simulated Consultation Assessment as part of membership examination [3]. Simulation around emergencies which can occur in PC is an area where traction to expand is being observed.

Methods:

Emergencies in PC simulation training sessions were offered to practices across the region over the last 12 months. The sessions were facilitated by members of the regional PC simulation faculty, who all hold clinical roles within PC, and are trained in simulation methodology. Broad learning objectives were set, and educators were enabled to feel these were fluid to allow for participant’s own experiences and views to be heard as the experts in their own practice environment, team, and culture.

All staff were invited to attend, including administration staff. SPs portrayed either the relative or patient and were integral to the debrief. Production of outcomes and changes identified to be made was owned by the practice team with support from the faculty. An end of course questionnaire was given to all participants.

Results:

Over the 12-month period 58 sessions were delivered and responses received from 630 learners in 55 different PC roles.

98% agreed or strongly agreed that it was relevant to their development needs. Emergent themes from qualitative feedback concerned increased awareness of exemplary communication as a team, with the patient and relative and other organisations. That the simulation illuminated the value of all staffs’ roles and improved the sense of team and working on a shared goal was a strong theme, with evidence this was due to the programme being designed, led and delivered for PC-by-PC. A final theme around leadership and followship was also identified.

Discussion:

Simulation on emergencies which can occur in PC is valued by staff and has potential to enable SBE to be adopted within PC to the benefit of patients and practices.

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.

References

1. Barry IS, Scalese RJ. Best evidence on high-fidelity simulation: what clinical teachers need to know. Clinical Teacher 2007;4(2):73–77.

2. Bray L, Krogh TB, Østergaard D. Simulation-based training for continuing professional development within a primary care context: a systematic review. Educ Prim Care Off Publ Assoc Course Organ Natl Assoc GP Tutors World Organ Fam. 2023;34(2):64–73.

3. Simulated Consultation Assessment (SCA) [Internet]. [cited 2024 Apr 30]. Available from: https://www.rcgp.org.uk/mrcgp-exams/simulated-consultation-assessment.

In 2023, in response to the 2022 Ockenden report, a national labour ward co-ordinator (LWC) framework was developed by NHS England [1]. This framework acknowledges the unique role of a labour ward/delivery suite co-ordinator.

Multi-professional PROMPT training currently takes place locally, but there has never been a course specifically designed to reflect the unique non-technical challenges of the co-ordinator’s role.

Methods:

A full-day simulation course (called D.i.S.C.O) was designed in collaboration with senior midwifery team members focusing on leadership, operational management, and communication. This course included three immersive simulation scenarios, and two forum theatres – all of which had debrief points mapped to the trust’s local leadership framework, and the national labour ward co-ordinator framework.

A feedback survey was used to evaluate the course on the day, and then followed up a month later to review the lasting impact (ongoing). Within the survey, co-ordinators were asked to score relevance and difficulty of scenarios, as well as give qualitative feedback on what they found helpful or what they would change. Specifically, they were asked to comment on reflections about their own leadership style during the day, linking in with the LWC framework, and what they would take back to their practice going forwards.

Results:

Over 90% of attendees agreed/strongly agreed that scenarios were appropriately pitched, relevant and allowed them to reflect on their own practice.

Specific comments in the feedback included the benefit of seeing different leadership styles as well as reflections on the benefit of being able to adapt approaches to different situations. Conflict resolution, and supporting junior colleagues were common themes that candidates found helpful with a suggestion to have more resources for conflict resolution which we were able to act upon for the second group.

Discussion:

Having external faculty, actors and using forum theatre helped to enable constructive debrief for this senior group, as evidenced by attendees’ feedback comments. From the discussions, not only were staff able to reflect on their own practice, but also able to brainstorm what changes to the system would help them in this role. Data on how these ideas have been implemented, as well as the longer-term impact on individuals will be collected within the follow-up feedback.

Going forwards, we hope to use these themes to support other senior healthcare teams.

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.

References

1. NHS England. Labour ward co-ordinator education and development framework. NHS England » Labour ward co-ordinator education and development framework. [Accessed 8 April 2024].

Recent data from the General Medical Council (GMC) highlight the significant presence of International Medical Graduates (IMGs) in the NHS, comprising 52% of new entrants in 2022 [1]. Despite their robust clinical knowledge, IMGs face higher referral rates to the GMC, possibly due to their unfamiliarity with the NHS [2]. It is therefore vital to improve on the integration and retention of IMGs who have a key role in alleviating the high pressure on the workforce within the NHS.

Methods:

A survey was conducted among IMGs to identify their learning needs and exposure to simulation training. Five scenarios utilising high-fidelity manikin and simulated actors were developed, including mental capacity assessment, end-of-life escalation, cardiac arrest event, anaphylaxis management and sepsis recognition whilst working with a challenging colleague.

Pilot sessions, each involving six IMG participants, were conducted. Post-scenario debriefings targeted key curriculum themes, ranging from A to E assessment to escalation of care. Feedback was collated using a questionnaire featuring a mix of open and closed questions graded on a 5-point Likert scale.

Results:

Survey findings reported that 45% of respondents had no prior exposure to simulation training, while 7% were uncertain about its concept. 96% expressed keen willingness to attend simulation sessions if provided the opportunity.

Participant feedback indicated high satisfaction with content and delivery, with increased confidence in managing acutely unwell patients and navigating challenging situations related to human factors. Many found the debriefing sessions particularly helpful in addressing areas of improvement. Suggestions for program improvement included pre-session information, run-through of an A to E assessment and a mix of live and manikin simulated patients for enhanced realism.

Discussion:

The transition of IMGs to a new country, lacking an established support system, presents an undeniably daunting challenge. Beyond disparities in healthcare systems, language and cultural differences further compound the integration process. To address this, we prioritised tailored training to meet the unique needs of IMGs.

Simulation training has emerged as a transformative tool, offering a safe environment to develop technical and non-technical skills while mitigating risk to patient safety. Moreover, the program aims to instill concepts of human factors, equipping IMGs to navigate common medical, ethical, and legal challenges within the NHS.

Feedback collected represents a limited sample size. A collaborative effort with stakeholders to secure support and resources will ensure the effectiveness and sustainability of future simulation sessions for IMGs.

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.

References

1. The General Medical Council. The state of medical education and practice in the UK: workplace experiences 2023. [Internet]. 2023. Available from: https://www.gmc-uk.org/about/what-we-do-and-why/data-and-research/the-state-of-medical-education-and-practice-in-the-uk. [Accessed 29 April 2024].

2. Lane J, Shrotri N, Somani BK. Challenges and expectations of international medical graduates moving to the UK: An online survey. Scottish Medical Journal. 2024;00369330241229922.

Acknowledgments:

We express our sincere appreciation to the members of the Simulation Faculty at University Hospital Coventry and Warwickshire for their invaluable contributions to this project. Their dedication made this project possible and provided support to international medical graduates throughout their journeys.

The Centre for Snakebite Research & Interventions at the Liverpool School of Tropical Medicine (LSTM) houses >150 venomous snakes. This includes the black mamba (Dendroaspis polylepis) which can cause life-threatening features within 30-minutes of envenomation [1,2]. Early care is essential to prevent death and disability, with the Royal Liverpool University Hospital (RLUH) being the closest point of care.

Clinicians, snakebite experts and herpetologists updated an existing standard operating procedure (SOP) for the safe transfer and acute management of occupational snakebite envenoming between LSTM and RLUH. In-situ simulation was used to test the SOP, as well as the ability of RLUH to receive such a patient.

Methods:

We conducted an in-situ simulation of a black mamba envenoming at the LSTM herpetarium, utilising a simulated patient. The scenario continued in real time to arrival and management in the emergency department (ED).

Implementation of the SOP was evaluated by senior clinicians and snakebite experts with further feedback obtained during a human-factors focused debrief.

Results:

Several processes that required review were identified. These included:

Key roles and responsibilities for the LSTM staff needed further clarification particularly in regard to the responsibility of communicating information to RLUH clinical teams:

● Handover between teams as information was not fully cascaded to all the relevant clinical teams

● There was limited knowledge and experience within the ED in managing snakebite envenoming

● Lack of clarity with regards to how to seek expert assistance and escalation from the assessing clinician

● Lack of familiarity of anti-venom risking inappropriate administration.

Discussion:

As a result of the in-situ event several improvements to the SOP have been implemented. These include:

● The development of first and second responder roles at the LTSM

● Clearly defined communication responsibilities

● Specific pre-alert routes between the LTSM and RLUH

● Refinement of a quick reference guide for ED doctors and decision to transfer this with the patient to aid in a timely and informed assessment

● Expired anti-venom will no longer be transferred with the patient, but is available at LSTM if guided by expert advice.

It is expected these changes will result in improved management of occupational snakebite envenoming however, this is an iterative process. Existent SOPs require further review, and a simulation scenario is being developed to improve familiarity amongst the ED clinicians. We plan to repeat the in-situ simulation and include other clinical teams to identify any additional latent errors.

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.

References

1. Aalten M, Carsten B et al. The Clinical Course and Treatment of Black Mamba (Dendroaspis Polylepis) Envenomations: A narrative review. Clinical Toxicology. 2021;59(10):860–868.

2. Závada J, Valenta J et al. Black mamba dendroaspis polylepis bite: a case report. Prague Medical Report. 2011;112(4):298–304.

Acknowledgments:

Thanks to all the staff at the Liverpool School of Tropical Medicine and Royal University Hospital Liverpool who took the time to participate in the simulation.

Multi-casualty major incidents require effective coordination of many agencies, including prehospital and hospital teams. Simulation as a tool for interprofessional learning is well-established within healthcare [1]. However, it is unusual for healthcare and emergency services to collaborate within multi-agency simulation. Given the resources and planning required to deliver this [2], there are logistical challenges to deliver a joint, immersive simulation experience for healthcare and non-healthcare professionals in a major incident context [3]. Furthermore, there are challenges inherent to involving different professional groups, each with their own educational backgrounds and cultures.

The authors explore:

● How can varying simulation approaches be aligned for a common purpose in the context of multi-agency major incidents?

● How best can a variety of participants be engaged in simulation when each have their own learning needs?

Methods:

A major incident simulation occurred in an urban city centre re-creating a road traffic collision and concurrent river-based rescue. This was facilitated by fire and health services, however involved a larger multi-agency response, with more than 100 participants, including individuals from the police and coastguard. Undergraduate nursing, paramedic, medical and journalism students were involved with support from embedded faculty. Registered nurses and emergency medicine trainees also attended.

Healthcare professionals adopted the role of casualties, triaged and transported rescues, observed multi-agency communication strategies, and undertook initial patient assessments within a simulated emergency department. Various simulation approaches were implemented throughout the exercise including fully immersive components, ‘pause and play’ effects, and real time observational discussion. Faculty reflections were collated from hot and cold team debriefs to evaluate the impact on learning and the challenges of facilitating an immersive multi-agency simulation.

Results:

Based on these reflections, we analysed the challenges and conflicts involved with running a multi-agency simulation. A key theme from this was the use of simulation across, and through, several boundaries. This included the challenges of balancing postgraduate and undergraduate learning needs within the same educational environment; utilising multidisciplinary teams to enhance interprofessional learning; awareness of the different approaches to systems hierarchy; simulation strategies within different agencies; coordinating facilitation between agencies; and the impact of hospital-based healthcare professionals working in an unfamiliar pre-hospital setting.

Discussion:

This work can inform future multi-agency simulations and prompt consideration of new approaches to interdisciplinary and interprofessional learning. This experience challenged the usual norms of simulation by traversing several boundaries including across agencies, professions, simulation approaches and techniques, hierarchical structures, and undergraduate and postgraduate learning spaces.

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.

References

1. Murphy M, Curtis K, McCloughen A. What is the impact of multidisciplinary team simulation training on team performance and efficiency of patient care? An integrative review. Australasian Emergency Nursing Journal. 2016;19(1):44–53.

2. Saiboon IM, Jaafar MJ, Harunarashid H, Jamal SM. The effectiveness of simulation based medical education in teaching concepts of major incident response. Procedia - Social and Behavioral Sciences 2011;18:372–378.

3. Simpson E, Sharp K, Paterson S, King C, Stark C, McGowan N. Planning an immersive multi-agency major incident simulation. International Journal of Healthcare Simulation. 2(Suppl 1).

Acknowledgments:

Acknowledgement to the Scottish Fire and Rescue Service for their collaboration in this learning event.

The inherent challenge in learning radiography lies in the inability to confirm the correct positioning of a person until the resultant x-ray is examined. Spurious use of ionising radiation is unlawful and unethical, so radiography education has been limited to the teaching of theoretical concepts reinforced by practical placement learning. Latterly, the profession has introduced procedural simulation using radiographic phantoms or interactive electronic media [1], but immersive simulation involving patient journeys and procedures is uncommon due to the need to expose the subject to ionising radiation.

Simulation in mammography education is further limited by the intimate nature of the procedures and the radiosensitivity of the breast. Immersive simulation, providing technical and non-technical learning has not been described in the literature, but we posited that it would be highly beneficial to learners, as breast imaging and interventional procedures require excellent communication and technical proficiency.

We describe a pilot study undertaken to transform mammography education; whereby immersive simulation was used to follow a patient journey in a high-risk situation in breast imaging and advanced practice.

Methods:

The study involved 37 learners and a blended immersive simulation, whereby learners interacted with a human simulated person (SP) and a voiced manikin, when necessary, to remove risk of harm to the human SP. The manikin underwent an assessment of a breast mass involving different imaging modalities (Figure 1-A18) and communication challenges over 5 hours. Industry partners facilitated the simulation and academics facilitated learner debrief.

Figure 1-A18.

Results:

Anecdotal evidence was collected from all attendees. Learners suggested that the communication issues and techniques discussed during the event would be used in their future practice. Industry partners were enthusiastic about their inclusion and were keen to participate again.

Discussion:

Literature suggests the quality of the individual’s experience during breast imaging is crucially dependent on the radiographer’s interpersonal skills [2]. Performing radiological interventional procedures requires high haptic sensitivity and fine motor skills [3]. The pilot study garnered anecdotal feedback from learners suggesting that this method of teaching and learning satisfied both needs.

Industry partners have since repeated the exercise for their application specialist trainees, suggesting that this also holds value for ‘training the trainers’ who teach those who use the equipment.

In conclusion, it is possible to transform radiography education and include industry partners by using immersive simulation. The study continues to gather evidence to support the use of immersive simulation of this type for radiography education and for future research.

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.

References

1. Sujar A, Kelly G, García M, Vidal FP. Interactive teaching environment for diagnostic radiography with real-time X-ray simulation and patient positioning. International Journal of Computer Assisted Radiology and Surgery. 2021;17(1):85–95.

2. Clark S, Reeves PJ. Women’s experiences of mammography: A thematic evaluation of the literature. Radiography. 2015;21(1):84–88.

3. Chellali A, Dumas C, Milleville-Pennel I. Haptic communication to support biopsy procedures learning in virtual environments. Presence: Teleoperators and Virtual Environments. 2012;21(4):470–489.

E-Delphi is a popular online health and educational research technique to improve decision-making processes and obtain agreement on formulating healthcare standards [1]. This is a cost-effective and efficient technique that offers participants flexibility in contributing from anywhere, anytime, compared to traditional Delphi [2].

Simulation-based Education (SBE) deliver a realistic teaching approach and standardised experience within a harmless learning environment [3]. Formulating SBE strategies in academic settings is needed to enhance the learning experience and promote equal educational exposure. This study aims to develop novel SBE Strategies at the University of Manchester (UoM).

Methods:

Different quality standards were reviewed based on selective strategies from various associations, including the International Nursing Association for Clinical Simulation and Learning (INACSL) standards, the Society for Simulation in Healthcare (SSH) Accreditation Standards, the Association for Simulated Practice in Healthcare (ASPiH) SBE in Healthcare Standards Framework and Guidance, and the National Framework for SBE.

A panel (n=43) was established using purposive sampling according to their credentials in the SBE field during the first round and then increased to (n=45) in second and third rounds, including UoM faculty, global experts, postgraduates or early career, and UoM undergraduates.

The Delphi process consisted of three rounds/ surveys; each survey encompassed three areas: Connectivity, Collaboration, and Partnerships; Promoting Quality; and Stability, Sustainability, and Growth of SBE. The study acceptance consensus rate was 80%. Data were collected between September and December 2023.

Results:

By the end of three Delphi rounds, there was an overall 90% agreement, and many were accepted at 100% consensus. The Delphi surveys started with 29 SBE strategies in the first survey, then increased to 35 SBE strategies in the second survey, and finalised with 39 SBE strategies in the third survey. The study response rate was 35, 29, and 27, respectively. Final SBE strategies are illustrated in Table 1-A17.

Discussion:

Employing these SBE strategies within faculty is essential as it is considered an innovative teaching modality in healthcare. However, logistics could be a challenge associated with implementation, and resources required for this investment need to be identified. In this study, there was a great number of participants engaged in the Delphi rounds with a good response rate. In addition, the variability of panel role, profession, and level indicated a variety of opinions, which is the core of Delphi study. Also, it strengthened study findings by identifying the different expectations of the SBE strategies acquisition at UoM.

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.

References

1. Green RA. The Delphi Technique in educational research. SAGE Open. 2014;4(2):2158244014529773.

2. Donohoe H, Stellefson M, Tennant B. Advantages and limitations of the e-Delphi technique. American Journal of Health Education. 2012;43(1):38–46.

3. Alfes CM, Rutherford-Hemming T, Schroeder-Jenkinson CM, Lord CB, Zimmermann E. Promoting interprofessional collaborative practice through simulation. Nursing Education Perspectives 2018;39(5):322–3.

Acknowledgments:

Funding: King Saud bin Abdulaziz University for Health Sciences.

Table 1-A17.

Simulation-based Education Strategies

1. Connectivity, Collaboration, and Partnerships
1.1 Leadership and Governance
1.1.1 Appoint a lead/s for Simulation to lead the development and implementation of the Simulation Strategy and report progress to the Faculty Leadership Team. Leadership will be clearly defined, and appropriate governance models and processes will be explicitly described.
1.1.2 Review and clarify academic programme and technical support structures and leadership roles in relation to simulation, and articulate roles and responsibilities to ensure parity across faculty (including workload tariff) and goals of simulation regularly (e.g., every two years).
1.1.3 Develop and facilitate collaborative working relationships with Technical Services Operational Managers to better understand the roles and responsibilities of simulation technicians/technologists and ensure colleagues have clear career pathways with access to ongoing training and development.
1.1.4 Develop and facilitate collaborative working relationships with Information technology (IT) Services and E-Learning Support Teams to promote the sharing of ideas, taking responsibility for innovation and best practices in using simulation and immersive technologies to enhance the learning experience.
1.1.5 Develop and facilitate ongoing relationships with executive stakeholders, faculty/organisational development teams, quality improvement and assurance, teaching and learning teams.
1.1.6 Appoint student representatives with clearly defined roles and responsibilities to inform the development of simulation.
1.1.7 Work with the Social Responsibility and Public Engagement Team to ensure strategies, plans, and goals align with Patient and Public Involvement and Engagement (PPIE) principles, e.g., PPIE representation in steering groups.
1.2 Communications and Networking
1.2.1 Establish a Community of Practice and/or Steering Committee with clear mechanisms to share best practices, learning, and expertise across all university healthcare programmes, including cooperation with, for example, but not limited to, the Association for Simulated Practice in Healthcare (ASPiH), International Nursing Association for Clinical Simulation and Simulation Learning (INACSL), Society for Simulation in Europe (SESAM), and Association of Standardized Patient Educators (ASPE).
1.2.2 Develop a digital platform/virtual learning environment to promote effective communication pathways, share resources (e.g. iRIS and e-learning for health) and expertise, showcase best practices, and facilitate collaborations across simulation within the university.
1.2.3 Continue to develop and establish liaisons with external stakeholders relevant to individual healthcare simulation training requirements, including professional regulatory and statutory bodies, Royal Colleges, and NHS (National Health Service) Trusts, ensuring protected time for Discussion via regular meetings.
2. Promoting Quality
2.1 Training and Development
2.1.1 Provide new and existing academic staff/faculty member, delivering simulation, with flexible and accessible training opportunities in simulation pedagogy as part of continuing professional development by completion of simulation development programmes such as, but not limited to, the Certified Healthcare Simulation Educator (CHSE), and Simulation Faculty Development Programme (e.g., e-lfh.org.uk).
2.1.2 Provide new and existing academic staff/faculty member delivering simulation with flexible and accessible training opportunities in immersive technology, e.g., Virtual Reality, Artificial Intelligence, and Serious Gaming based on the curriculum and intended learning outcomes for programmes.
2.1.3 Support new and existing academic staff/faculty member delivering simulation to continue developing knowledge and skills in the debriefing process, including meta-debriefing as appropriate.
2.1.4 Support academic staff/faculty member delivering simulation to participate in advisory committees, professional or practice-based simulation forums, or networks as part of continuing professional development.
2.1.5 Develop and implement a roadmap for professional development designed specifically for academic staff/faculty member delivering simulation. The professional development plan and/or pathway should include, but not be limited to, membership and engagement with professional Simulation Networks, attendance at local/regional/national/international conferences, completion of Simulated-Based Education study days/courses, and achievement of individual accreditation with a relevant simulation association.
2.1.6 Support simulation technicians/technologists in the development of knowledge, skills, and behaviours that will enable them to continue to provide consistent, high-quality simulation in safe learning environments by completion of professional registration with the Science Council, e.g., Simulation Technician Level 3, and Certified Healthcare Simulation Operations Specialist certification (CHSOS) scope.
2.1.7 Develop and implement an internal mentorship programme and/or peer-shadowing opportunities to provide continuous support and professional development of academic staff/faculty member/simulation technicians, delivering simulation.
2.2 Standards and Quality Assurance
2.2.1 Raise awareness and promote the application of Healthcare Simulation Standards of Best Practice, including, but not limited to: Association for Simulated Practice in Healthcare (ASPiH), International Nursing Association for Clinical Simulation and Learning (INACSL), Society for Simulation in Europe (SESAM), Association of Standardized Patient Educators (ASPE) and Simulated Patient Common Framework Checklist (Health Education Northwest).
2.2.2 Embed Healthcare Simulation Standards of Best Practice into the design and development of all simulation activities, and consider programme/organisational accreditation, as appropriate, with a relevant simulation association.
2.2.3 Ensure that staff designing and delivering simulation are knowledgeable of the ethical standards of simulation-based experiences and adhere to the Healthcare Simulationist Code of Ethics.
2.2.4 Use a periodic review and feedback process to ensure all simulation activities delivered across faculty, are feasible, appropriately designed based on programmatic resources, and in alignment with the simulation strategy. This will be measured by quality assurance processes, e.g., annual evaluation of programme simulation activities, incorporating outcomes data, learner, academic staff/faculty member, and external stakeholders’ feedback.
2.2.5 Undertake a training needs analysis to identify training and development needs for academic staff/faculty member delivering simulation and simulation technologists/technicians, using, for example, the Simulation Educational Needs Assessment (SENAT) tool.
2.2.6 Engage in annual peer-review processes to ensure ongoing development of academic staff/faculty member delivering simulation.
2.2.7 Establish a clear process and/or system of reviewing simulation resources, e.g., standards of best practice, e-learning materials, evidence-based practice, and training and development courses, to ensure academic staff/faculty member/ simulation technologist/technicians remain up to date.
2.3 Research and Evaluation
2.3.1 Commit to undertaking evaluations of all aspects of simulation activity (i.e., briefing or pre-brief, simulation activity, debriefing, simulated patient’s skills in portraying their role) to determine the quality and/or effectiveness of the simulation-based experience on an individual, divisional, school or faculty level. Evaluation should map to learning evaluation models, e.g., Kirkpatrick, and include feedback from learners, academic staff/faculty member, simulated/standardised patients, Equality, Diversity and Inclusion (EDI) leads, and external stakeholders.
2.3.2 Facilitate appropriate training and supervision for academic staff/faculty member designing and delivering simulation to develop research projects and evaluation processes that consider educational effectiveness and efficiency, patient safety, quality of care, and the preparedness of learners for the workforce.
2.3.3 Establish systems to actively support and promote the dissemination of outcomes/findings from research and/or evaluation processes in professional/scientific journals, and internal and external conferences.
2.3.4 Disseminate evaluation data internally (with proper anonymisation), promoting recognition and improvement at an individual, division, school, and faculty level.
3. Stability, Sustainability, and Growth of SIM
3.1 Accessibility
3.1.1 Review current specialist teaching spaces with a view to developing a system/process for sharing spaces, e.g., Aseptic Suite, to increase capacity for simulation delivery and enhance learner’s experience of simulation.
3.1.2 Map existing simulation equipment and auditing processes, e.g., part-task trainers, full-body manikins, advanced procedural trainers, and VR (Virtual Reality) headsets, with a view to developing a system/process for sharing equipment to increase capacity for simulation delivery.
3.1.3 Ensure full-body manikins, part-task trainers, and avatar-based simulation, represent all patient populations, e.g., race, ethnicity, age, various body sizes, and disability, to promote equity, diversity, and inclusion.
3.1.4 Review the use and training of simulated patients across the faculty, with a view to establishing a pool of simulated patients, ensuring that they are trained for the roles that they are required to undertake, including providing feedback and debriefing in line with evidence-based practice, and reflect all patient populations to promote equity, diversity, and inclusion.
3.1.5 Identify a learning space to build and develop an innovative simulation centre/hub to increase capacity for simulation delivery, including Interprofessional-Enhanced Simulation.
3.1.6 Ensure digital innovations are accessible for all learners, ensuring an inclusive approach to teaching and learning.
3.2 Preparation and planning
3.2.1 Assess academic staff/faculty member readiness for simulation growth, e.g., workload, role and responsibility, training, and development needs.
3.2.2 Forecast programme/faculty growth for simulation, including personnel (academic staff/faculty member, simulation technicians/technologists), Information technology (IT), E-learning, and Librarian support, workload, roles and responsibilities, training and development needs, simulation equipment and facilitates, ensuring equity of access for learners across all healthcare programmes.
3.2.3 Explore and identify priorities, benefits, challenges, and solutions for incorporating simulation and immersive technologies into all healthcare programmes within the faculty, using, for example, the Simulation Culture Organizational Readiness Survey (SCORS).
3.2.4 Develop and implement a quality assurance framework to enable continuous progress in simulation preparation, planning, delivery, and integration into new healthcare programmes.
3.3 Finance
3.3.1 Prepare an operational budget considering current and future goals and priorities, including identifying fixed (e.g., maintenance and service contracts), variable (e.g., personnel, reimbursements for simulated patients, consumable items, training and development for staff and simulated patients, peer review, audit, dissemination of research and scholarly activity) costs, future capital expenditure, and human resources.

In the UK, where no established curriculum or specialized course is dedicated to emergency medicine (EM) referral skills, there is a pressing need for a comprehensive training program.

A 2022 survey of 148 EM doctors and 279 doctors from in-hospital specialities in Northern Ireland found that 73% of EM doctors struggled with referrals, while 79% of in-hospital doctors felt EM referrals were of low quality. A novel simulation-based referral skills pilot course was developed, offering education, practice opportunities, feedback, and assessment.

Methods:

A specifically designed simulation-based education (SBE) was delivered on the 8th of November, 2023, in Craigavon Area Hospital. The simulation was delivered by four faculty members and attended by fifteen EM ACCS trainees. The objectives were to teach the EM Drs to Stop, think, and prepare before referral, use the SBAR referral tool, show assertiveness, and stop deflection. Four challenging referral scenarios were delivered, mirroring a real-life situation that EM doctors often encounter (Argumentative, bossy, dismissive, and challenging clinical referrals). The Scottish Centre debriefing model was used, and the following microteaching topics were delivered (reactions to difficult situations, assertiveness, stopping deflection, redirecting behaviour, conflict management styles, and emotional intelligence).

Results:

The impact of the simulation program was significant. Of the 15 attendees, 60% had never received any training on referral skills. However, post-simulation, their confidence in making referrals improved from 13% to 80%. 87% rated the simulation high quality and 13% very high quality. 100% felt that the simulation would change their future practice and would recommend it to other EM Doctors. A follow-up questionnaire conducted five months post-simulation received ten responses, with 87% reporting a significant improvement in their referral skills.

Discussion:

While simulation programs in EM traditionally focus on resuscitation, trauma and procedural skills, there is a lack of emphasis on referral skills. Some EM specialists argue that referral skills are acquired through experience rather than formal training. Consequently, junior doctors rarely receive guidance on how to conduct referrals. Inadequate handovers have been associated with events and clinical errors in emergency medicine due to communication and missing information [1]. SBE expands medical education, recreating clinical settings for teaching, practising, and assessing. Trainees learn from mistakes and receive feedback. It is effective for teaching ED-specific skills [2]. The results of this pilot SBE on EM referral skills were promising and encouraging to expand its delivery at a broader scale.

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.

References

1. Moslehi S, Masoumi G, Barghi-Shirazi F. Benefits of simulation-based education in hospital emergency departments: a systematic review. Journal of Education and Health Promotion. 2022;11(1):40.

2. Hock SM, Cassara M, Aghera A, Saloum D, Bentley SK. Attending physicians as simulation learners: summary of current practices and barriers in emergency medicine. Clinical and Experimental Emergency Medicine. 2024. ceemjournal.org

Acknowledgments:

The simulation program was funded by the Northern Ireland Medical Dental Training Agency.

Currently, 1.7 million CYP are living with chronic illness in the UK [1]. The growing pressures on the National Health Service (NHS) call for a rethink in the planning and delivery of healthcare to foster inclusivity and empowerment of both healthcare professionals (HPs) and primary caregivers (PCGs). Empowering PCGs to initiate lifesaving interventions in emergencies in the community could lessen the burden on the NHS primary care, ensure optimum outcomes, and facilitate Patient and Family-Centred Care (PFCC) for these children and young people (CYP).

Simulation-based education (SBE) as a modality for medical education has immense benefits but the evidence is skewed towards HP [2, 3]. This position paper explores the potential role of simulation in enhancing the education of PCGs for CYP with chronic illnesses by highlighting its benefits, challenges, and future implications. It proposes that PCGs being adult learners like HPs could experience similar benefits from SBE if learning activities are appropriate.

Methods:

This paper evaluates the benefits and drawbacks of using SBE for PCGs education under three educational outcomes: Knowledge Acquisition for early detection of clinical deterioration; Technical Skills Acquisition for confidence to initiate home management; and Non-Technical Skills Acquisition for management in the community.

Based on these outcomes, a literature review was conducted across three online databases (PubMed, University of Edinburgh Library [DiscoverED], and Google scholar). Relevant articles were explored under these outcomes and conclusive opinions were drawn. Anticipated challenges to this intervention were highlighted and recommendations for implementation were proffered.

Results:

In the context of CYP, 6 studies demonstrated increment in knowledge acquisition for PCGs following SBE whilst 1 study showed no difference in this regard.

For Technical Skills Acquisition and Confidence, 5 studies showed positive impact and no study was found of contrary opinion. Unfortunately, no study was found that explored Non-Technical Skills Acquisition in this context. Proposed challenges for SBE implementation in PCGs education included funding, fidelity logistics, and psychological safety concerns.

Discussion:

Despite the paucity of evidence in this regard, available evidence showed that the experiential learning opportunities provided by SBE can equip PCGs with the knowledge, skills, and confidence needed to deliver high-quality care in diverse community settings. Additional benefits of SBE in this context include reduction of parental anxiety management, interprofessional collaborations, and peer-to-peer learning.

Successful implementation of this intervention requires cross-organizational partnerships and a robust funding scheme. This Investment in PCG education would decrease healthcare system pressures, drive PFCC, and improve outcomes for these CYP.

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.

References

1. NICE [Internet]. Managing long-term conditions in the community, NICE. 2024. Available from: https://www.nice.org.uk/about/what-we-do/into-practice/measuring-the-use-of-nice-guidance/impact-of-our-guidance/niceimpact-children-and-young-peoples-healthcare/ch2-managing-long-term-conditions-in-children#:~:text=There%20are%201.7%20million%20children,pressure%20on%20emergency%20hospital%20services. [Accessed 20 April 2024].

2. Sharma R. et al. Modalities and essentials of simulation facility for facilitation of clinical skills to medical and nursing students: Need for the present era. Journal of Surgical Specialties and Rural Practice. 2022;3(1):1.

3. Barghi-Shirazi F, Moslehi S, Masoumi G. Benefits of simulation-based education in hospital emergency departments: A systematic review. Journal of Education and Health Promotion. 2022;11(1):40.

Simulation Based Learning (SBL) is a relatively new concept in the Pharmacy profession [1]. In 2024, NHS Education for Scotland (NES) has made participation in SBL mandatory for Foundation Training Year Pharmacists and those completing the NES General Practice Clinical Pharmacist (GPCP) framework. The aim of this project was threefold: to determine if this type of education could be offered to all Pharmacists working in Primary Care, to evaluate the benefits to Pharmacists’ development and to determine if it could be delivered out with a dedicated simulation suite.

Methods:

The first step was to describe the concept of SBL to the Pharmacy team and explore how it may be beneficial in the development of Pharmacists. The next step was to determine whether there was a suitable location locally to deliver SBL within a Primary Care setting. In keeping with the NES initiative to enhance pharmacy education using SBL, we conducted a pilot study. We initially carried out one session with 4 participants, each doing one scenario focussing on non-technical skills. The plus/delta model was used to de-brief the scenario. Participants were given a pre and post evaluation survey, seeking their views on how they felt before and after participating in SBL, with questions focussing on their confidence in certain areas.

Results:

The session ran smoothly, showing that the logistics of delivering SBL within a Primary Care setting, and out with a dedicated simulation suite was possible. The pre and post evaluation surveys showed that Pharmacist confidence grew in terms of general review of patients, clinical decision making, managing complex patients and giving/receiving feedback from colleagues. This SBL has now been extended out to several other Primary Care Pharmacy teams within the health board, showing similar increased levels of Pharmacist confidence in the above areas.

Discussion:

SBL is a valuable tool to support the development of Pharmacists within Primary Care. We recommend the use of SBL across the Pharmacy profession, including those working in different sectors, and at different grades e.g. pharmacy technicians.

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.

References

1. Lloyd M, Watmough S, Bennett N. Simulation-based training: applications in clinical pharmacy. The Pharmaceutical Journal. 2018.

Acknowledgments:

Acknowledgements to Andrew Christopherson and Neil McGowan from NHS GG&C, and also the NES simulation team for their support.

Fires within operating theatres are rare but can have grave consequences for patients and staff. Transferring an anaesthetised patient in an emergency carries significant risk. The recent ‘Fire safety and evacuation guidelines’ published by the Association of Anaesthetists, recommends multidisciplinary fire evacuation training be incorporated into annual mandatory training [1]. A purpose-built four table ‘Barn operating theatre’ opened in 2023 as part of transformation works at University Hospitals Dorset. Barn theatres are large open-plan surgical spaces. Each patient is operated on in a dedicated operating area, separated by mobile screens. Barn theatres are unique environments, with very few in the United Kingdom. Large-scale multi-casualty fire evacuation simulations of a barn theatres have not been conducted previously in the UK. The primary aim of this exercise was system testing and to identify any unknown latent safety risks.

This collaborative project was conducted with: the Fire Safety team, the Quality & Risk team, the Head of Emergency Planning, Resilience and Response, the Theatre Management team, the Theatre Educators, and the Simulation Team.

Methods:

Fire simulations were conducted with three multidisciplinary theatre teams who each, simultaneously, had a patient who was at a different peri-operative phase. Two simulations were run with the “fire” occurring at different locations within theatre. Scenarios were designed to increase the risk of a failure occurring by increasing cognitive load on the staff involved. The end point was safe evacuation of patients. Each operating team had a debrief and then shared key points with the larger group. Switchboard was also engaged in this event.

Results:

Teams completed timely evacuations without major challenges, but there were a number of near-misses. Findings highlighted:

● The importance of communication and co-ordination between neighbouring teams within the barn theatre.

● The need for vertical evacuation devices closer to theatre.

● The benefits of pre-packed transfer bags.

● The importance of making the 2222 fire call.

● An obstructed evacuation route.

Discussion:

It would not be feasible to run practical sessions for all staff members, so the focus was on testing the new systems and processes. Each team brought a different perspective with slightly differing agendas, such as, are we testing individual’s knowledge, use of front-loaded education, and managing the interaction of simulation as an education tool versus enhancing fidelity for systems testing. This project generated several safety recommendations and provided evidence for additional funding and changes to procedure and infrastructure.

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.

References

1. Association of Anaesthetists. Fire safety and emergency evacuation guidelines for intensive care units and operating theatres: for use in the event of fire, flood, power cut, oxygen supply failure, noxious gas, structural collapse. 2021. Available from: Fire safety and emergency evacuation guidelines for intensive care units and operating theatres | Association of Anaesthetists.

Sudden Unexpected Death in Infancy (SUDI) is a traumatic scenario for the professionals involved. A unique set of skills are required to manage this effectively and due to its uncommon nature, professionals may be dealing with this tragedy for the first time. The first NI Multi-Agency SUDI Protocol outlining expectations of staff is being developed on following recommendations in the Kennedy Report [1]. Despite all this, comprehensive training does not currently exist in Northern Ireland. An innovative simulation-based course with multi-agency involvement and parental involvement was designed to address this gap in training with specific focus on delivering family-centred care and conducive multi-professional working.

Methods:

An immersive simulation-based course was designed to align with the goals of both the 2023 Interim Protocol and the draft Multi-Agency Protocol. It was piloted on 25th April 2024 in Craigavon Area Hospital Simulation Suite and delivered to 8 senior doctors/higher-specialty trainees within Paediatrics and Emergency Medicine. A robust faculty made up of consultants with SUDI expertise, paramedics, senior police, a Coroner, clinical psychology, actors - as well as the voice of a parent’s experience via a surrogate - allowed for invaluable insight. Directors of the Public Health Agency (PHA) Child Death Programme observed with interest for Protocol influence. High-fidelity simulations focused on futile resuscitation and delivering compassionate family care. The unique role of the police and Coroner as well as clinical psychology to promote staff wellbeing was delivered via interactive sessions. Pre- and post-questionnaires were completed.

Results:

The course had significant impact on participants, faculty and members of PHA. Of the 8 participants, 62% had never dealt with a SUDI scenario, 78% lacked confidence in management and 100% lacked a good understanding of the role of the medical team and other agencies in the investigation of these deaths. 100% of participants reported improved confidence and understanding across all domains. Awareness of where to seek personal mental health support also improved from 0% to 100%. The effect of actors was described as ‘invaluable’ and ‘hauntingly accurate’. Faculty feedback was overwhelmingly positive.

Discussion:

Simulation-based training for SUDI is emotionally charged and can be difficult but there is a desire for such training and the benefits are enormous as evident in the feedback. There is significant interest from PHA and other stakeholders to roll this out as a regional initiative and redesign to target police participants in a multi-professional approach similar to other parts of the UK.

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.

References

1. Sudden unexpected death in infancy and childhood Multi-agency guidelines for care and investigation The Royal College of Pathologists Pathology: the science behind the cure [Internet]. 2016. Available from: https://www.rcpath.org/static/874ae50e-c754-4933-995a804e0ef728a4/Sudden-unexpected-death-in-infancy-and-childhood-2e.pdf.

Interprofessional Education (IPE) helps improve collaboration between different professionals working in Intensive Care Units (ICU) improving clinical outcomes and staff well-being. In-situ simulation (ISS) has been increasingly used in ICU settings to reproduce real-life clinical issues. In Whiston ICU, ISS is undertaken as an IPE intervention, allowing doctors and nurses to train together in the clinical environment. This evaluation explores how the ISS programme produces interprofessional outcomes for different staff groups, whether undertaking simulation in the clinical environment impacts this, and what features of the programme help make inter-professional simulation effective.

Methods:

A qualitative realist evaluation approach was adopted to create and then test hypotheses about how the ISS programme might work to produce interprofessional learning [1]. These Initial Programme Theories (IPTs) were constructed using documentary analysis and from discussions with the designers and facilitators of the ISS programme. Ten IPTs were tested and refined by two methods. PubMed was searched to identify potential mechanisms which might facilitate or impede interprofessional learning [2]. At the same time, qualitative data collection, consisting of non-participant observation of ISS, semi-structured interviews and an interprofessional workshop was undertaken in Whiston Hospital ICU staff. Triangulation of qualitative data and the literature was used to test and refine IPTs.

Results:

One Non-Participant Observation was undertaken. Two doctors, three nurses and one medical student were interviewed, and four doctors and six nurses attended an interprofessional workshop. Iterative refining of IPTs using computer-assisted qualitative data analysis software (NVivo) [3]; allowed the identification of three relevant contexts (a busy ICU with high clinical acuity, the clinical environment of the ICU, and new/junior vs. experienced/senior participants) and four mechanisms which facilitate successful interprofessional ISS. These were ‘Planning and Logistics’, ‘Interdependence’, ‘Embodiment’ and ‘Psychological Safety’; this allowed the generation of two middle-range theories:

1. In a busy ICU with high clinical acuity, a well-planned ISS allow staff from different healthcare professions to participate without distractions from clinical work.

2. Well-designed ISS encourages interdependence among healthcare professionals, clarifies different professional roles, and promotes the transfer of interprofessional skills to practice.

Discussion:

ISS is a valuable tool in IPE. To be successful it requires careful planning and organisational support. Emphasis should be placed on ensuring a diverse but equitable mix of professions, with interprofessional instructional design of scenarios to create simulations which cause interdependence between different professions to solve clinical problems and engender embodiment in participants to improve role clarity and transfer to 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.

References

1. Pawson R, Tilley N. Realistic Evaluation. 1997. Sage.

2. Hewitt G, Sims S, Harris R. Using realist synthesis to understand the mechanisms of interprofessional teamwork in health and social care. J Interprof Care. 2014;28(6):501–506.

3. Dalkin S, Forster N, Hodgson P, Lhussier M, Carr SM. Using computer assisted qualitative data analysis software (CAQDAS; NVivo) to assist in the complex process of realist theory generation, refinement and testing. International Journal of Social Research Methodology. 2021;24(1):123–134.

The UK government has mandated 50% foundation doctors complete a 4-month placement in General Practice (GP) [1]. This means that GP trainees have completed most of their previous training in a hospital environment. As a result they have less exposure to primary care systems and ideas for quality improvement projects (QIP) which may be completed by other members of the health care team within the hospital setting.

During the coronavirus pandemic a GP emergency simulation course was developed to support trainee wellbeing and enhance induction. We have continued this course as part of our ST1 induction and over time we have adapted our debriefs to help trainees identify some quality improvement projects they could complete as part of their mandatory training [2].

Methods:

We use 5 scenarios and use reflective questions to suggest potential QIP ideas.

● Scenario 1 – Hypoglycaemia in a diabetic patient during Ramadan

Does your practice have a policy for diabetic patients during Ramadan?

● Scenario 2 – Anaphylaxis

Do you know where your emergency drugs are located and are these monitored?

● Scenario 3 - Baby with meningitis

Does your practice have a protocol for managing unwell children and summoning colleagues for help?

● Scenario 4 - Acute psychosis

Does your practice have a protocol for managing patients who are agitated/ potentially aggressive and may require detention?

● Scenario 5 - Palliative care home visit

Does your practice update key information for palliative patients including their wishes for final place of care.

Results:

Many trainees have subsequently introduced quality improvement ideas which will improve patient safety and communication within their practice, and are evidence of transformative simulation [3].

Examples include:

● Introducing anaphylaxis bag – protocol/ drug doses and medication all stored within one area and checked on a regular basis.

● Introducing meningitis bag – as above.

● Developing leaflet for patients with diabetes practising Ramadan

● Protocol within practice highlighting Ramadan and potential changes to diabetic medications for all clinical staff.

Discussion:

Whilst quality improvement is not the primary objective of this course it appears to be a positive outcome. Prior to this many trainees commented that they thought quality improvement projects were “completing an audit.” Following this course, they felt positive about practical ways to improve patient safety and systems within the practice, and actually make a difference. We will continue to encourage trainees to participate in quality improvement and aid patient and practice safety and trainee development.

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.

References

1. Department of Health. Delivering high quality, effective, compassionate care: developing the right people with the right skills and the right values: A Mandate from the Government to Health Education England. 2013.

2. Royal College of General Practitioners. WPBA: Quality Improvement Project (QIP). 2024. Available from: https://www.rcgp.org.uk/mrcgp-exams/wpba/qip. [Accessed 30 April 2024].

3. Weldon SM, Buttery AG, Spearpoint K, Kneebone R. Transformative forms of simulation in health care – the seven simulation-based ‘I’s: a concept taxonomy review of the literature. 2023.

The Integrated Care Programme for Older Persons in Ireland (ICPOP) aims to change the way health and social care for older persons is planned and delivered, with the goal of improving patient experience, quality and outcomes.

Implementing integrated care for older adults is a complex task requiring a collaborative approach among several healthcare disciplines and working environments. Interprofessional simulation-based education (SBE) provides an ideal learning environment for probing the current system of care, providing opportunity to identify key issues that are compromising the patient journey so they can be actioned in a meaningful way. Here we outline our experience of using simulation to enhance the care journey for the older adult.

Methods:

Two interprofessional simulation scenarios were designed and facilitated by an expert panel in the simulation laboratory. Multi-disciplinary team members from the Frailty at the Front Door (FFD), specialist geriatric ward (SGW) and Integrated Care Programme for Older Persons (ICPOP) participated. The scenarios worked through the health care journey of patients within the ED and acute hospital setting, incorporating multidisciplinary discussions, onward referrals and communication processes between the different teams. There was a facilitated debriefing session afterwards among participants, stakeholders from hospital, community and national programmes. Feedback was obtained following both scenarios in an anonymous online questionnaire.

Results:

Twenty-three participants provided feedback following both scenarios. Overall, participants enjoyed participating in the simulation and reported that they would be eager to engage in future SBE. The simulation highlighted areas for quality improvement pertaining to existing communication structures. All participants stated they found the simulation relevant to their area of practice and expressed that their practice would change as a result of the simulation, with improved communication noted as a key learning outcome by many. Participants noted that relationships developed through SBE could lead to the delivery of more efficient patient care and better patient outcomes.

Discussion:

Through SBE we identified key areas for quality improvement for older adults moving between multidisciplinary services. Future SBE sessions are planned to explore the continuum of older adult care bringing together teams from primary care, rehabilitation and specialist inpatients services.

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.

As demand for emergency care escalates, Emergency Departments (EDs) seek to create capacity by commissioning temporary clinical spaces, such as mobile units attached to infrastructure, or via entire new-build departments. Expanding and modernising the areas in which treatment is delivered aims to improve the quality of care by increasing capacity within the system; however, moving to new spaces presents challenges and opportunities [1]. In-situ simulation (ISS) has been used in the literature to test new builds [2], but often with a theoretical basis that safety threats can be found and fixed without a full exploration of everyday clinical work, and often lacking a longitudinal view of risks or opportunities that emerge after moving into the new environment. Modern EDs are appreciated as socio-technical systems, where work is completed by teams using specialised tools and equipment, and staff constantly adapt how they work to meet inherently variable demands. Safety II (SFII) is an approach to understanding complexity in healthcare systems that has developed into a coherent set of guiding principles, but it requires further application in emergency care [3].

Methods:

Ethical approval was not required for this work as it was a service evaluation. A multidisciplinary team developed a mix of clinical and non-clinical multimodal simulations (n=30) delivered in the newly built ED two weeks before move-in. Seventy-seven staff members from multiple cross-boundary professional groups participated in the project. ISS were designed to identify latent safety threats (LSTs), illuminate practice variability in Everyday Clinical Work (ECW), and understand how staff adapt to manage demands, informing better system learning. After move-in, the team facilitated longitudinal feedback by organising focus groups to understand how staff had adapted to the new environment.

Results:

Forty-four LSTs were identified for action or mitigation, Table 1-A8. The Simulation Coordination Team (SCT) also redesigned several patient pathways by learning from descriptions of everyday clinical work and then streamlining processes. After moving into the new build, the 4-hour Emergency Access Standard improved by 4.41%, the average time a patient was seen within 60 minutes by a senior decision maker improved by 2.67%, and the average ambulance handover achieved within 30 minutes improved by 6.33%.

Discussion:

The SCT found that combining ISS with SFII theory promoted a better understanding of ECW, adaptations, and threats to the system before moving to the new build. Engaging multiple stakeholders, from executives to external teams, created learning opportunities and shaped better responses to demands.

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.

References

1. Patterson MG. In situ simulation: detection of safety threats and teamwork training in a high-risk emergency department. BMJ Qual Safety. 2013;125–133.

2. Francouer CS. It takes a villages to move hospital: simulation improves intensive care preparedness for a move to a new site. Hosp Paediatrics. 2018.

3. Anderson JR. Beyond ‘find and fix’: improving quality and safety through resilient healthcare systems. International Journal of Quality in Health Care. 2020;204-211.

Table 1-A8.

Description of simulation, Testing, LST(s), and Mitigation/Action

Sim Ref	Simulation	Testing(Process/ Pathway)	LST(s) Identified/ Categories	Mitigation/ Action
1	Patient Journey:Chest Pain	• Logical flow through ED to:○ Assessment area○ Ward○ Discharge• Streaming routes• Pre-assessment cubicle suitability	1.  The reclining chairs in the pre-assessment/ECG rooms are not fit-for-purpose so can these be static examination couches? Can we consider the same for Triage? (En)	1.  Appropriate examples sent to project management - purchased and in situ before new build move
2	Collapse at triage:Cardiac Arrest	• To assess in triage room and move to resus/cubicle• Space and availability of equipment	2.  Why are there two emergency buzzers? (En/T)3.  Will Vocera work throughout the build? (En)4.  Where are the emergency buzzer panels? (En/T)5.  Where are the otoscopes/ ophthalmoscopes going? (En)	2.  Build/project team state it is new regulations3.  Additional access points for WIFI are now installed and all “black spots” identified and resolved before move4.  Shown to sim team, panels still required programming – completed before move5.  Discussed with clinical team. Fitted in every cubicle on a side wall at the head-end of the wall
3	Transfer to CT of critically unwell patient:Elderly Abdo Pain	• Logistics of space• Availability of equipment and routes.	6.  Do we get priority for the pod system if others are queued? (En)7.  Where is the alert phone going? Will there be a ringer in resus? (En)	6.  Pod system has not changed. Project team advised no impact on ED.7.  Will be positioned at the Nurse in Charge (NIC)/ Emergency Physician In Charge/ Progress Chaser Desk. No ringer in resus.
4	Transfer to theatre of trauma patient.	• Communication with theatres• Distance from New ED	8.  Pathway development conversation (T/P)9.  Do we have any new syringe drivers? (Eq)10. Is there telemetry in resus (as you cannot see the patient in Bay 1 from sat at the nurses desk for example)? If so, does it alarm at the desk or just in the bay? (Eq)	8.  Direct to theatre pathway.9.  Medical library to implement a process for medical devices ED have a total of 24 pumps. ED now have syringe driver and infusion pump charging stacks in ED for majors and resus.10. Yes, central monitoring in resus and at NIC staff base and alarms at all telemetry stations.
5	Collapse on way to Ambulatory Care	• Time for response to emergency buzzer from different areas• Space and logistics	11. Are we finalised on labelling above doors of areas? (See and Treat for example is not labelled from the Major’s side which has caused confusion when moving patients during a number of sims) (En)	11. Signage is yet to be complete - once installation has been finished we can complete a walk through - FBC installed - further additions now on order - awaiting install date from TDC
6	Prepare for transfer to a different hospital	• Admin logistics (printing/ photocopying)• Logistics of ambulance attendance	12. The doors are very heavy - assuming this is just because they will be automatic? (En)	12. They are automatic – not turned on for a number of sims as work still ongoing.
7	Major Haemorrhage:Trauma	• Maj Haemorrhage protocol• Distance from blood bank• Time for blood to get to New ED	13. Can we have clocks and whiteboards in every resus bay? (En/Eq/P)	13. Clocks and whiteboards ordered and fitted before move.
8	Major Trauma:Adult	• Ambulance pt to resus from ambulance bay• Familiarisation of trauma team with New ED• Trauma network awareness• Location of equipment in New ED	14. Screens needed for resus (in case we need to split cubicles for major incidents etc.) (En/Eq)	14. Additional screens made available to ED before move.
9	Major Trauma:Paediatric	• Ambulance patient via ambulance door to resus compared to moving them to Paeds ED• Availability of equipment (major trauma kit)• Introducing trauma team to new resus.• Knowledge of how to manage paeds trauma patient and trauma network• Step-up vs. step-down Paeds ED and Resus	15. Can we have a joint adult and paediatric airway trolley in all resus bays? (Eq)	15. They are not big enough for both sets of equipment, so will remain separate.
10	Cardiology:ST Elevation Myocardial Infarction	• Walk in process of how chest pain managed via triage• Assessment of pt in space available• Availability of equipment (ECG machines etc.)• Bring through for ECG in pre-assessment rooms behind triage• Transfer to majors vs. resus.• Where to get drugs from in majors and resus	16. Are there drugs in triage? (Eq)17. Is there canulation kit in triage, or just in the post-triage intervention/ECG rooms? (Eq)	16. Paediatric triage has drug cupboards, we can move the current drug cupboard from triage in the retained estate into one of the triage rooms. New cabinets now ordered - awaiting install date17. Stock was to be defined by clinical teams. There is cannulation equipment in triage.
11	Aortic Dissection	• Moving from corridor to resus• Arterial line equipment• New monitor set-up• Use of syringe drivers in new space• Transfer bag suitability	18. Can we have emergency buzzers in the long corridor? (En/P)	18. Yes - awaiting install date.
12	Cardiology:Bradycardia	• Level 2/3 care in the space we have• Medical management of bradycardia including pacing and drugs	19. New telemetry monitors will need testing (Eq/En)	19. Tested and functional
13	ED Operations and Escalation:Trust-wide Tabletop	• Triage Delay• Bed Wait• Staffing Crisis (Nursing and Medical)• Ambulance Offload Delay• Internal Critical vs. Major Incident• Full Resus• Multiple Cardiac Arrests• IT Service Failure• Phone/ Bleep Failure• POD Failure• Mass Strike Action (e.g. 72-hour walk-out)• Delays with non-admitted patients/ peaks in activity	20. ED Operations and Escalation Plan update needed (P)	20. Update dynamic and being reviewed
14	COPD:Type 2 Respiratory Failure	• Access to equipment in resus• Level 2/3 care• Use of NIV in new resus• IT and communication infrastructure	21. Why is there medical air ports in Resus - previous incident meant they were capped-off in old ED. (Eq/En/T)	21. Health and Safety team aware, medical air requested at design stage and restricted. Approved by medical advisor committee, they all have different outlets to Oxygen - removable caps attached before move which is aligned to the Risk Assessment.
15	Overdose:Calcium Channel Blocker	• Use of high dose glucagon/ insulin• Do we need “poisons box” in Pharmacy• IT and communication infrastructure	22. Discuss with Pharmacy regarding a box of 30 Glucagon and rotation into live-stock when dates get close (Eq/P)	22. Implemented in resus drugs room.
16	Infection Risk:Negative Pressure Room	• Test negative-pressure room• Access from outside by ambulance	23. The negative pressure room needs to be resus specification. (En/Eq)	23. Negative pressure room will have full resus specification before handover.
17	Minor Injury:Woundcare Simulation	• Access to minors cubicles• Storage of woundcare equipment• Process of senior advice from minors for complex wound	24. Why is there no main desk for notes in See and Treat? (En)25. Are there x-ray screens in S&T? (En/Eq)26. Is there equipment in S&T for Oxygen etc? If not, why are there ports?27. Door codes need to be more intuitive, or the codes will no doubt be written on the door frames. (En/T)28. S&T cubicles need to have basic analgesia including local anaesthetic and equipment. (Eq/En/T/P)	24. There are desktop computers in every cubicle in See and Treat (S&T)25. Yes, Picture Archiving and Communication System (PACS) screen installed before move.26. Yes, all cubicles are configured the same.27. Door codes have been changed to be more intuitive28. The aim is to have a drugs cupboard in S&T. Equipment trollies in situ before move.
18	Pregnant:Resuscitative Hysterotomy	• Access to equipment in resus• Use of multiple teams in new space	29. Further discussions as per point 8	29. Further discussions as per point 8
19	Cardiac Arrest:Adult	• Familiarisation with new environment• Familiarisation with equipment	30. We need level 3 care trollies in the main department (Eq)31. Do the big glass doors in the main department have any way of becoming opaque (En)	30. Additional trollies purchased and stocked.31. Yes - there are curtain rails on the inside. Curtains fitted before move.
20	Cardiac Arrest:Paediatric	• Familiarisation with new environment• Familiarisation with equipment	32. New buzzer system has two separated colours (blue and red) need to twist lenses so blue is outermost and more visible for higher-priority emergencies (En/T)	32. Split removed from every lens – now entire fitting flashes the colour
21	Rapid Tranquilisation:Adult	• Availability of drugs• Availability of expert help• Emergency buzzers and Vocera badges• Ease of access to guidelines• Difficult airway drills and support	33. The ventilators in resus need to be in an intuitive/ergonomic position as ITU would struggle to set it when ventilating due to size of bay (En/Eq)	33. When bays set up, trolley moved closer to head of cubicle than centre as bars are fixed to wall.
22	Rapid Tranquilisation:Older Adult	• Availability of drugs• Availability of expert help• Emergency buzzers and Vocera badges• Ease of access to guidelines• Post-procedural logistics	34. X-ray waiting area is a potential risk for patients if we are unable to guarantee escorts due to buzzer system in retained estate not linking to new build (P/En)	34. Current buzzer systems ring in retained estate - x-ray will need to call 2222 when ED move. Email sent to radiology and resus team to ensure new process
23	Overdose:Rapid Sequence Induction	• Availability of kit• Speciality ease of access• Speed of medication collection	35. RSI drugs box would be useful (Eq/T)	35. Box agreed by Pharmacy and contents decided by ED and ITU teams
24	Hypothermia	• Rewarming therapies and availability• Distance for supporting equipment	36. New warmer required (Eq)	36. Funding identified and ordered
25	Sedation:Complicated fracture reduction	• Availability of drugs• Availability of expert help• Emergency buzzers and Vocera badges• Ease of access to guidelines• Post-procedural logistics	37. More computers are required for note taking (Eq/P)	37. 6 computers installed in cubicles and 8 new computers-on-wheels ordered - feedback from clinicians during workshops that laptop-safe is being used more often
26	Major Haemorrhage:Medical (Gastrointestinal Haemorrhage)	• Re-test process after changes made• Speed of blood product availability in new space	38. Ascites pathway discussed - work towards looking for Same Day Emergency Care space or input (P)	38. Care Group are discussing – will depend on priorities of the division of Medicine and Long Term Condition
27	Paediatric:Peri-arrest	• Timely response of teams• Access to equipment	39. Moving paediatric patients to resus will split paediatric nurses and takes longer the old build (En/T/P)	39. Resus bay identified in paediatric emergency department and stocked as resus. Paediatrics will be treated in paeds rather than resus when condition and staffing would deem this safer for patients
28	Neonatal:Resuscitation	• Existing equipment suitability	40. Need a new resuscitaire - current one is outdated, not fit-for-purpose or robust (Eq)	40. Uniformity with new purchases within maternity/neonatal areas – same model of resuscitaire procured.
29	Mental Health:High Risk/Absconding	• Buzzer configuration	41. New buzzer system - needs labelling correctly (En)42. New buzzer system - needs every emergency pull (red and blue) to ring in all areas (En/P)	41. Programming signed off and tested42. Programming signed off and tested
30	Major Incident:Multi-Agency Simulation	• Test the new build is fit for purpose to manage a mass casualty incident• Test layout and newly formulated major incident plans are fit for purpose• To test flow throughout the new build in a major incident	43. Major Incident Plan and training need amending in line with feedback (Eq/P)44. Uniformity of triage systems with statutory ambulance service would be useful (P)	43. Amended and new training rolled out as mandatory for ED staff44. Procured and will be used when delivered

Key: Equipment (E^q); Environment (Eⁿ); Teams (T); Process (P)

In response to concerns highlighted by the Ockenden Report [1] and East Kent Maternity Services Report [2] healthcare organisations are seeking innovative strategies to address deficiencies in service delivery. This, coupled with a Care Quality Commission (CQC) report of a large Trust’s maternity services, revealed several significant shortcomings in maternity care, including failures in teamwork, professionalism, and communication.

Methods:

A workshop-based approach utilising simulation was informed by an extensive fact-finding process, involving one-to-one and group interviews with consultants, midwives and managers. This ensured a comprehensive understanding of the issues raised in the national and local reports and facilitated the customisation of scenario-based simulations to address specific areas of concern. Two separate site three-day workshops consisted of scenario-based simulations with actor role players using adapted forum theatre techniques with debriefing, reflection and action planning. Demonstrating support for the principles and values agreed by the extended team was essential; this included appreciating shared values and common goals, being open, honest, showing mutual respect, trust, kindness and feeling comfortable to be heard but also listen, and challenge.

Results:

Feedback from participants and data collected during the simulations indicated a positive impact on participant understanding, confidence, and skills. Participants reported improved awareness of the issues highlighted in the reports and expressed increased confidence in their ability to address them. Subjective outcomes were:

● 58% increase in feeling comfortable to initiate a challenging conversation with a more senior colleague.

● 83% increase in the perception that by not starting a challenging conversation with a colleague the individual takes no responsibility to improve the culture

● 60% increase in the ability to listen actively to others when an issue affects them directly and their viewpoint is different.

Discussion:

Utilising simulation in the development of a local response to the Ockenden and East Kent maternity services reports proved to be an effective strategy. Two simulation-based ‘I’ categories were identified: inclusion and identification [3]. This was a valuable opportunity for participants, as key stakeholders, to practice and refine their skills in a safe environment, and, through simulation, to identify, discover and recognise what was happening for them in their unit. Discussion was rich, honest, challenging and illuminating. This approach holds promise for replication in other healthcare settings seeking to address similar challenges in service delivery and quality improvement.

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.

References

1. Ockenden D. Ockenden report - final [Internet]. GOV.UK. Crown; 2022. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1064302/Final-Ockenden-Report-web-accessible.pdf.

2. Kirkup B. Maternity and neonatal services in East Kent: “Reading the signals” report [Internet]. GOV.UK. 2022. Available from: https://www.gov.uk/government/publications/maternity-and-neonatal-services-in-east-kent-reading-the-signals-report.

3. Sharon MW, Buttery A, Spearpoint K, Kneebone R. Transformative forms of simulation in health care – the seven simulation-based ‘I’s: a concept taxonomy review of the literature. International Journal of Healthcare Simulation. 2023.

In-situ simulation (ISS) is a form of simulation-based learning that takes place in real clinical settings, with benefits including the identification of system vulnerabilities, refinement of protocols and improvement of inter-professional dynamics, all without endangering patients [1]. This theoretical basis for learning is underpinned by situativity theory and principles such as the systems engineering initiative for patient safety (SIEPS) [2]. We report on the use of ISS prior to the relocation and expansion of two existing ICUs totalling 31 beds into one new purpose-built 55-bed facility, as part of a redevelopment of the Royal Sussex County Hospital in Brighton.

Methods:

A number of high-fidelity multidisciplinary simulations were held in the new facility prior to relocation, followed by detailed documented team debriefs to identify safety themes. Simulations included unanticipated cardiac arrest and difficult intubation. Scenarios were conducted in a variety of open bays and negative pressure side rooms to maximise learning. Additional timed simulations were conducted for time-critical ITU transfers such as the computed-tomography (CT) scanner, theatre complexes and interventional radiology suites.

Results:

Key themes were the accessibility of emergency equipment as well as challenges in the ergonomics and layout of the new unit. Barriers to emergency medication access and the need for improvements to the bedspace nomenclature were also raised. Feedback from staff was universally positive with common themes being a greater level of preparedness and familiarity with the new environment. The simulations also identified potential challenges with staffing templates on the new unit. As illustrated in Figure 1-A6, safety issues were fed back to their relevant medical and nursing leads to develop strategies to improve safety.

Discussion:

We highlight the successful implementation of ISS within a QI framework to aid the safe relocation and expansion of a large critical care facility. We are now exploring the ongoing use of multidisciplinary ISS on the new critical care unit, with other scenarios such as raised intracranial pressure under development. Critical aspects of this model are the need for key stakeholder buy-in and staff engagement at all levels, with appropriate senior oversight throughout.

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.

References

1. Calhoun AW, Cook DA, Genova G, Motamedi SM, Waseem M, Carey R, et al. Educational and patient care impacts of in situ simulation in healthcare. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare. 2024;19(1S).

2. Carayon P, Schoofs Hundt A, Karsh B-T, Gurses AP, Alvarado CJ, Smith M, et al. Work system design for patient safety: The SEIPS model. Quality in Health Care. 2006;15(suppl 1):i50–8.

Figure 1-A6.

A six-stage quality improvement methodology for service development and evolution utilising in-situ simulation

Good clinical documentation provides evidence for safe, high-quality, continuous patient care. Nevertheless, fostering effective nursing documentation practices in this digital age remains a significant challenge. Time-consuming and burdensome perceptions towards documentation, negatively impacts maintenance of accuracy and legal prudence [1]. Following organisation-wide implementation of digitised health records, an internal review highlighted significant variation in nursing documentation practices. The limited extent traditional pedagogical approaches can meaningfully improve documentation [2] prompted exploration of alternative strategies to identify and address perceived contextual barriers to effective digital documentation. Drawing on improvement methodology, this educational initiative aimed to transform electronic nursing documentation by encouraging critical thinking, evidencing of rationale behind contributions to nursing care and realigning to the nursing process.

Methods:

A simulation-based workshop was developed with stakeholders and delivered to 75 nurses and healthcare assistants in one UK acute hospital. Pedagogically informed by the process of double loop reflection [3], the workshop consisted of three simulated exercises centred around a single-patient, pre-recorded scenario; 1) electronic documentation of a care episode, 2) writing a witness statement for the coroner, and 3) presenting at a mock coroner’s court inquest. Each activity was followed by a facilitated debrief. The aim was to encourage participants’ to critically evaluate their underlying perspectives and documentation practices to transform habitual thinking and actions beyond standardised electronic templates. Participants completed a pre and post-course surveys to evaluate the learning intervention.

Results:

There was an overall increase in self-reported confidence in documenting challenging clinical situations, with the proportion of those ‘completely’ confident increasing by over threefold from 9.4% to 32.4%. Several themes emerged during qualitative analysis. This included changes in perspective towards nursing documentation with a particular emphasis on importance, thoroughness, and efficiency alongside an intention to change documentation practice. Systemic and cultural factors were also identified as potential inhibitors to changes in behaviour.

Discussion:

Simulated experiences that actively engage participants in critical reflection and discourse can provide transformative learning experiences in nursing. Immediate self-reported changes in participants’ perceptions of the evidential quality of digital documentation suggests promise that may support future changes in practice. However, the process also surfaced barriers to action and change, including systemic and cultural factors. This will inform ongoing organisational learning regarding enhancing documentation effectiveness. Future work will focus on expanding and evaluating the longitudinal impact of this educational intervention and supporting wider improvement efforts to address the identified contextual barriers.

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.

References

1. De Groot K, Triemstra M, Paans W, Francke AL. Quality criteria, instruments, and requirements for nursing documentation: A systematic review of systematic reviews. Journal of Advanced Nursing 2019. 2019;75:1379–13931.

2. Bunting J, de Klerk M. Strategies to improve compliance with clinical nursing documentation guidelines in the acute hospital setting: a systematic review and analysis. SAGE Open Nursing. 2022;8.

3. Argyris C, Schon D. Organizational learning: A theory of action perspective. Reading, Massachusetts: Addison-Wesley Publishing Co; 1978.

Within NHS organisations, administrative staff play a crucial yet often overlooked role in communication and upholding organisational values. Over 500,000 of 1.2 million NHS staff, work in the vital range of fields that support clinical care [1]. These staff receive 0.01% of the NHS training budget, yet they have a significant interface with patients, the public and colleagues [1]. Building upon previous success, this study aims to expand the rollout of simulation-based training to include administrative staff in both inpatient and outpatient settings.

Methods:

The expanded rollout utilised a hybrid approach, offering face-to-face workshops and live online sessions to reach administrative staff across inpatient and outpatient settings, over a large geographical spread. Fully briefed actors enhanced the simulation scenarios, which focused on communication domains crucial for administrative tasks. Building on previous experience of participant reluctance, an emphasis was placed on collaborative co-design with the participant groups. Demonstration, immersion, and feedback through 3.5hours of simulation involved simulated patients/relatives/colleagues (actors). The scenarios focused on four domains of telephone, email, letter and face-to-face communication. Emphasis on giving (and receiving) positive feedback was a vital thread.

Results:

A ‘pre and post’ evaluation method is used to assess increase in knowledge and confidence.

Before the workshop 42% of respondents expressed no, limited, or neutral knowledge about the importance of being able to change their communication style to suit the situation. After the workshop, 100% of respondents expressed good or excellent knowledge.

Before the workshop 61% of respondents expressed no, limited, or neutral knowledge about how to use de-escalation techniques with patients and relatives. After the workshop, 97% of respondents expressed good or excellent knowledge of this area.

A total of 340 administrators have attended the 14 development workshops, with one facilitator and four actors per workshop.

Discussion:

The expanded rollout of this simulation-based improvement initiative represents a transformative approach to addressing the training needs of administrative staff across inpatient and outpatient settings. By incorporating crucial elements such as co-design, simulation-based learning, and alignment with organisational values, the initiative enhances administrative performance [2,3]. The utilisation of actors and a hybrid delivery model ensures scalability and effectiveness in reaching a wider cohort of administrative staff. This scalable and replicable approach has the potential to benefit a wide range of NHS organisations, ensuring continuous improvement and alignment with organisational goals.

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.

References

1. Cowper A. Mobilising the NHS’s hidden army [Internet]. Health Service Journal. [cited 2024 Apr 28]. Available from: https://www.hsj.co.uk/interactive/mobilising-the-nhss-hidden-army/7004957.article.

2. Feder V, Fibiger K, Knaak S. On the very, very frontlines of mental health care. Psychiatric Services. 2019;70(2):148–50.

3. Paper Works: the critical role of administration in quality care [Internet]. National Voices. 2021 [cited 2024 Apr 28]. Available from: https://www.nationalvoices.org.uk/publication/paper-works-critical-role-administration-quality-care/.

The total number of all reported written complaints, in England, to hospitals, community health services and primary care in 2022-23 was 229,458 [1]. Common themes across these complaints are communication issues, patient care issues and a lack of adherence to the organisation’s values and behaviours. Simulation-based ‘I’s (SBIs) are a useful taxonomy for categorisation, with simulation-based ‘influence’ reported to have the potential to profoundly influence both the relational aspects of care, and the development of a collaborative culture [2]. In response to communication challenges, this SBI presents a transformative approach through co-designed simulation workshops.

Methods:

Information was collected from healthcare trusts, education providers, and directly from patients and carers, with the aim of addressing systemic issues, while fostering a culture of patient-centred care. This co-designed framework, ensured that the content of the workshops was based on real patient complaints, with the developed simulations verified by specialist departments for authenticity. The collaborative effort ensured relevance and applicability across diverse NHS settings. Expert facilitators, supported by trained actors, delivered eight sessions to multidisciplinary audiences. Both live online and face-to-face sessions, ensured accessibility across a large geographical area.

Results:

Evaluation feedback revealed the transformative impact of these workshops on participants’ communication skills and awareness of patient safety issues. Disjointed care and its consequences were a key takeaway, including the impact of how one single encounter can influence the care pathway. The co-designed approach facilitated meaningful engagement and resonated with attendees, regardless of organisational context, and stimulated empathy, deepening participants understanding of the patient or complainants’ perspective [3]. Pledges were made by all participants, ranging in breadth, from an individual change to changes within the healthcare environment.

Discussion:

The development and delivery of these workshops highlight the potential of co-designed simulation workshops as a replicable solution for enhancing communication and patient safety across NHS organisations [4]. By integrating real patient experiences with expert facilitation and actors, the workshops offer a transformative SBI learning experience that is influential across organisations. The nature of these workshops not only ensures relevance but also fosters a sense of ownership and accountability among participants. By actively involving healthcare professionals and patient’s experiences, in the design process, staff are empowered to address communication challenges proactively, ultimately improving patient outcomes and organisational culture. The widespread adoption of this approach has the potential to influence and drive systemic change within the NHS, promoting a culture of continuous improvement and patient-centred care.

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.

References

1. NHS England. Data on written complaints in the NHS, 2022-23 [Internet]. NHS Digital. 2023. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/data-on-written-complaints-in-the-nhs/2022-23.

2. Sharon MW, Buttery A, Spearpoint K, Kneebone R. Transformative forms of simulation in health care – the seven simulation-based ‘I’s: a concept taxonomy review of the literature. International Journal of Healthcare Simulation. 2023.

3. Visscher K. Experiencing complex stakeholder dynamics around emerging technologies: a role-play simulation. European Journal of Engineering Education. 2023;1–19.

4. Brazil VA, Purdy E, Bajaj K. Simulation as an improvement technique. In: Dixon-Woods M, Brown K, Marjanovic S, Ling T, Perry E, Martin G, editors. Elements of Improving Quality and Safety in Healthcare. Cambridge University Press. 2023.