Board 193 - Program Innovations Abstract Implementation of a Perioperative Emergency Manual with In-Situ Simulation Training (Submission #438)

Abstract

Introduction/Background Critical events in the operating room are stressful and demanding even for highly trained physicians and staff. Emergency manuals and other cognitive aids, such as checklists, can help deliver best practices to patients during critical events. The Stanford Emergency Manuala was developed by the Stanford Anesthesia Cognitive Aid Group (SACAG)b as a resource for perioperative critical events. Simulation-based studies have shown that accessibility of and familiarity with relevant cognitive aids are vital to their effective use.1,2 Additionally, roles such as "readers" (staff who elect to read sections of an emergency manual aloud) have been shown to improve team performance in simulated crisis situations.3 As part of a hospital quality improvement project, we implemented an in situ mannequin-based simulation training curriculum in our hospital operating rooms, along with embedding two Emergency Manuals in all operating rooms (ORs). We hypothesized that these training sessions would lead to a significant improvement in OR staff familiarity with and intended usage of Emergency Manuals. Methods Members of the OR staff were identified by a nurse educator to participate in a scheduled simulation session, grouped according to specialty group and OR shift. We ran a total of nine single-session training modules over five months. In total, 126 staff participated in the training curriculum, including 64 nurses (51%), 30 surgical technicians (24%), 15 operating room assistants (12%), 12 anesthesia technicians (9%), and 5 staff members from other operating room roles (4%). During each 50 minute session we introduced why and how to use the Emergency Manual, along with principles of Crisis Resource Management (CRM)4 in the context of in-situ simulations portraying intraoperative critical events. Scenarios were designed to represent rare, refractory and complex events. They consisted of two to three live actors playing supporting roles and a low fidelity manikin. We used equipment available in the OR as well as a simulated display of vital signs (Laerdal SimMan 2G) controlled by a simulation technician.c Active participants in the simulation scenarios were assigned predetermined roles while other trainees observed and took notes about Emergency Manual use and CRM behaviors. All participants subsequently actively contributed during the group debrief. Following each session, participants completed a standardized evaluation form and a retrospective post-intervention Likert scale-based self-assessment to evaluate awareness of, familiarity with and willingness to use the Emergency Manual during clinical situations. Following the training sessions, familiarity with the existence and format of the Emergency Manual increased significantly (p<0.001). Participants reported more willingness to use the Emergency Manual for pre-crisis educational review and as a resource for debriefing (p<0.001). Additionally, participants reported a significant increase in willingness to suggest the Emergency Manual for use during rare, refractory and complex events, including willingness to act as a "reader" (p<0.001). Participant satisfaction with the sessions was high, with many qualitative responses expressing desire for more trainings of this type. Results: Conclusion Successful clinical implementation of emergency manuals depends upon accurate content that is presented in a usable format, as well as accessibility, familiarity and clinical culture. We show that even brief in-situ simulation is an effective training model to promote OR staff familiarity with why and how to use a novel cognitive aid - in this case the Stanford Emergency Manual - and to increase planned behavior regarding its future use. Future goals will include further integration at the individual, team and systems levels, interdisciplinary in-situ trainings, as well as the assessment of real time usage of the Emergency Manual during critical events.