141 Simulation: a Tool to Optimize the Activation of Novel Hospital and Critical Care Pathway

Abstract

As part of the national COVID-19 response, an NHS Nightingale Hospital was established for our region. An initial cohort of patients was admitted with resource allocation, demanding that limitation of care be clearly defined, including avoidance of invasive ventilation. Within weeks, an increasing bed capacity need drove preparation to admit patients who might require escalation to mechanical ventilation. This shift in admission criteria demanded significant change to the hospital’s service provision, including the ability to stabilize and transfer critically ill patients from this satellite location to an acute partner trust The aim of this study was to perform a rapid, prospective analysis of the critical care patient pathway and surrounding environment at a novel Nightingale Hospital using high-fidelity simulation.Following a need assessment and discussion with stakeholders, The internal environment and infrastructure were adequate to perform the task. A significant number of latent threats were identified and actioned during the simulation (Latent threats found at the Exeter Nightingale hospital during simulated intubation of a critically unwell COVID-19 patient simulation with a high-fidelity manikin proved to be a useful and reproducible tool in developing and testing the systems involved in managing critical care patients at a novel hospital. In accurately simulating a real-time clinical scenario, the care pathway is experienced and contextualized within the team. It offers an opportunity to expose deficits in the system without causing harm (Kaba and Barnes, 2019). Evidence gathered can be easily and rapidly reported to operational leaders allowing timely decision-making, change implementation and mitigation of preventable risk. This makes simulation a cost- and resource-effective quality improvement method. In addition to patient safety process testing,