Tuesday 26 March 2013

New Horizons in Simulation and Patient Safety


I’m Back! It’s been a while, but please don’t mistake my delay in revisiting the blogosphere as a lack of activity in the world of social media. As you will see from my latest effort we have been very busy indeed.

Last week saw the profile of simulation and human factors in healthcare soar to new levels. The BBC broadcast a fascinating documentary as part of its “Horizon” series entitled “How to avoid mistakes in surgery”. The title was slightly misleading but aunty beeb can be forgiven for this, as they undoubtedly had one eye on the ratings. The programme contained little new material for those of us who have been working in simulation and patient safety for many years.

However, the impact of this on the public consciousness is not to be underestimated. Well done to Dr Kevin Fong also for making the subject matter so accessible. It is also worth mentioning that many of us would have felt entirely vindicated in our work as a result of this broadcast.

For us at the Centre for Simulation and Patient Safety in the North West of England, this much needed injection of vindication was occurring against the backdrop of our attempts to move simulation to new horizons in our own region (did you see what I did there?). We have been developing our capabilities around “in situ” simulation for some time. We have run a number of successful exercises within actual hospital settings. These have been single patient events, short in duration. A sort of “guerrilla sim” approach if you like.

However flushed with a heady mix of confidence, enthusiasm and a desire to break out of the confines of the Simulation Centre, we decided to up the ante somewhat. First of all came the Medical Emergency Team (MET) exercise. The recipe, sprinkle liberally four simulated patients around Aintree Hospital, Liverpool (including one collapsed outside Starbucks at the main entrance, my personal favourite) bleep the MET and stand back and watch as they go to work saving lives, albeit plastic lives. The results were amazing. The hospital was buzzing as the activity unfolded throughout the day. Visitors and patients appeared delighted, staff stood in awe. More importantly the MET found the experience and practice incredibly beneficial.

All of this would have been a very local affair if it wasn’t for social media, or more specifically Facebook. In my last blog I promised we would make a much bigger splash in these waters, and I think I can say we have delivered. Our facebook (shameless plug www.facebook.com/CentreforSimulationandPatientSafety) page’s reach rose from 16 in January to 2600 in February as a result of this exercise. By posting photos of the activity we were able to capture the imaginations of facebook users and raise the profile of our work.

So we come to last week. How could we capitalise on our successes in February. We got wind of the Horizon documentary following an email blast from a local trust, and the idea of a live web chat on Facebook just seemed a logical way to engage with our new found followers. Also, as luck would have it, we were planning a major simulation exercise at the Royal Liverpool Hospital on the same day as the broadcast.

This one was really testing the limits of our capabilities but thanks to the collaborative approach of the emergency department team and the Education team at the Royal we were able to pull of what I feel was one of our most spectacular simulation exercises yet. So what did we plan? Take not one, not two but three simulated patients into a live inner city emergency department and really test the systems and team work in a positive way with a focus on finding latent errors and team resource management.

We only managed to do two patients, as actual patients should of course always come first. The last thing we wanted was to jeopardise patient safet by carrying out a patient safety exercise! However we did manage to bring a simulated trauma and a patient with pneumonia into the department and have them managed by the actual hospital teams in their own clinical environments. 

This included a transfer to CT scan (see Facebook for a hilarious photo of Sim Man 3G’s head CT scan) and a transfer to Theatre. In the case of the septic patient a critical care review was arranged and the “patient" was intubated in the emergency department and made ready for transfer before the scenario was terminated.

So we had now carried out two highly visible and successful exercises, and had an eager audience ready to visit our social media pages to see the images and footage. How else could we engage with them? This is where the web chat came into its own. A perfect storm of simulation activity on the ground and in the workplaces, highlighting the importance of safety and practice and a wonderful opportunity for all of that to be crystallised into a discussion and reflective process based around a popular science programme on national television.

The result was 350 people following our live chat during the programme and 48 people contributing to the discussion, even though the multi-tasking involved in “facebooking” whilst trying to watch the telly caused some to lose situational awareness (human factors get everywhere don’t they). I have to say my enjoyment of the programme was enhanced by the ability to discuss it with others as it happened. Trust me we will be doing it again. We have to find someway to keep our social media audience happy, especially as they have grown in number to 3500.

I’ll be back soon………honest.

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