ABSTRACT
BACKGROUND: Early recognition and call for help, fast initiation of chest compressions, and early defibrillation are key elements to improve survival after cardiac arrest but are often not achieved. We aimed to investigate what occurs during the initial treatment of unannounced in situ simulated inhospital cardiac arrests and reasons for successful or inadequate initial resuscitation efforts. METHODS: We conducted unannounced full-scale in situ simulated inhospital cardiac arrest followed by a debriefing. Simulations and debriefings were video recorded for subsequent analysis. We analyzed quantitative data on actions performed and time measurements to key actions from simulations and qualitative data from transcribed debriefings. RESULTS: We conducted 36 simulations. Time to diagnosis of cardiac arrest was 37 (27; 55) s. Time to first chest compression from diagnosis of cardiac arrest was 37 (18; 74) s, time to calling the cardiac arrest team was 144 (71; 180) s, and time to first shock was 221 (181; 301) s. We observed participants perform several actions after diagnosing the cardiac arrest and before initiating chest compressions. Domains emerging from the debriefings were teaming and resources. Teaming included the themes communication, role allocation, leadership, and shared knowledge, which all included facilitators and barriers. Resources included the themes knowledge, technical issues, and organizational resources, of which all included barriers, and knowledge also included facilitators. CONCLUSION: Using unannounced in situ simulated cardiac arrests, we found that key elements such as chest compressions, calling the cardiac arrest team, and defibrillation were delayed. Perceived barriers to resuscitation performance were leadership and teaming, whereas experience, clear leadership, and recent training were perceived as important facilitators for treatment progress.
ABSTRACT
OBJECTIVES: The COVID-19 pandemic forced hospital organisation and healthcare professionals to prepare for large quantities of patients in isolation rooms. In situ simulation may seem promising in order to manage the organisational changes that the pandemic require. This study aims to investigate in situ simulations influence on healthcare professional's self-perceived preparedness to face the pandemic. DESIGN: A qualitative focus group study. SETTING: We conducted full scale in situ simulations over a 3-week period in April 2020, including 277 healthcare professionals, at a Danish University Hospital. Subsequently, six semistructured focus group interviews, including 22 participants from the simulations, were conducted in May 2020. PARTICIPANTS: 22 healthcare professionals participated in the focus group interviews. METHODS: The simulations consisted of a briefing, two scenarios focusing on acute respiratory insufficiency and correct use of personal protective equipment (PPE), and a debriefing. We conducted six focus group interviews using comparable semistructured interview guides focusing on the organisational restructuring of the departments and outcomes of the needs-driven simulation-based programme. We used thematic analysis to identify main themes. RESULTS: The informants perceived that the simulations resulted in positive experiences for the healthcare professionals and perceived the organisational changes as effective. They highlighted that simulation enhanced teamwork, demystified the COVID-19 disease, and improved skills, in correct use of PPE and acute treatment of COVID-19 patients. Data revealed that a predefined simulation task force including both experienced simulators and medical experts for facilitation of in situ simulation would be beneficial. CONCLUSION: In situ simulation may be useful to enhance learning on organisation and individual level during a pandemic. This educational activity could serve an important role in facilitating hospital preparation and education of large numbers of healthcare professionals during a healthcare crisis. Introduction of a simulation task force is suggested to handle coordination and rapid enrolment across the hospital.