O1 In situ simulation for general practice staff is a better preparation for meeting medical emergencies than traditional basic life support training

Abstract

General practice staff are required to receive regular basic life support (BLS) training.1 2 This does not cover the skills and knowledge to prepare the GP team for meeting the needs of acutely unwell patients. Additionally, cardiac arrests are uncommon in general practice.3 In 2018 – 2019 GPs in the Thames Valley were offered the opportunity to take part in a project to introduce in-situ medical emergency simulation as an alternative to their BLS mandatory update. Aim To determine if in-situ medical emergency simulation including BLS would be considered by the GP Multi-Disciplinary Team (MDT) a more appropriate preparation for managing medical emergencies. Methodology 22 practices where recruited into a two phase project sponsored by the Health Education England (HEE) Thames Valley. The session provided mandatory basic life support but also allowed staff to rehearse three medical emergency simulations in the clinical area using their own emergency equipment. Sessions were delivered by facilitators experienced in simulation and debriefing. All participants were naive to in-situ simulation. Participants were asked to complete questionnaires before and after the session to determine their views on their previous experiences with managing emergencies in Practice. Results 228 responses were reviewed. 64% had encountered a medical emergency within the last year. The most common being acute coronary syndrome, sepsis, acute asthma and respiratory exacerbations. When calling for an ambulance, 51% reported delays some of up to 3 hours. 39% of the clinical staff questioned said they had not had any specific medical emergency training since working in a hospital. A further 27% had medical emergency training but between 3 – 20 years ago. After training, staff were questioned on the training they had received. The themes most prevalent are displayed in „figure 1: 98% felt that simulation including BLS best prepared them for emergencies. 93% said they would like to see in situ simulation become standard training for general practice. Conclusion Candidate feedback demonstrates that experiential learning was the preferred modality of education for managing medical emergencies. We propose that there should be a move away from training focused solely on BLS and that mandating bodies should consider replacing it with in-situ medical emergency scenarios including BLS delivered by qualified facilitators in the work place. This would better reflect the physical environment and human factors that practices encounter and better strengthen confidence and competence in dealing with high stress, low frequency events. References CPR, AED and safeguarding requirements. May 2020. RCGP. https://www.rcgp.org.uk/training-exams/training/mrcgp-workplace-based-assessment-wpba/cpr-aed-and-child-safeguarding.aspx Quality Standards for Primary Care. May 2020. Resuscitation Council UK. https://www.resus.org.uk/library/quality-standards-cpr/primary-care. Bury G, Prunty H, Egan M, Sharpe B. Experience of prehospital emergency care among general practitioners in Ireland. BMJ Open 2013; 3:e00256310. Halls A, Kangagasundaram M, Lau-Walker M, Using in situ simulation to improve care of the acutely ill patient by enhancing interprofessional working: a qualitative proof of concept study in primary care in England. BMJ Open 2018. 028572. Uttley E, Suggitt D, Baxter D, Wisam J. Multiprofessional in situ simulation is an effective method of identifying latent patient safety threats on the gastroenterology ward. Frontline Gastroenterology 2020;0:1–7. Reid J, Bromiley M. Clinical human factors: the need to speak up to improve patient safety. Nursing Standard 2012;26:35–40.