Resident acute deterioration simulation series: Does repetition equal improvement?

ABSTRACT

INTRODUCTION: In 2018, we implemented the Resident Acute Deterioration Simulation Series. High-fidelity simulation is now an integral part of our intern curriculum. This study was an effort to assess this curriculum. Our primary hypothesis was that repeat exposure to the same clinical scenario through simulation would increase critical action completion rate, decrease the time to critical action, and improve intern comfort in dealing with these acute clinical situations. METHODS: Interns completed four high-fidelity simulations over the course of the academic year. For each simulation, a critical action checklist was developed. During each session, interns were timed with the action completion rate and time to each critical action recorded. Interns were debriefed after the scenario. They completed the same scenario within a one month period, again with their action completion rate and time to critical actions recorded. They also completed pre and post session surveys measuring comfort managing acute patient deterioration. RESULTS: Due to the COVID-19 pandemic, we were able to complete and record data for 2 simulation scenarios in their entirety- status epilepticus and status asthmatics. For both scenarios, there was an improvement in action completion rate, with the status epilepticus scenario increasing by 40% (40% of critical actions completed in the first simulation and 80% on repeat) and the status asthmaticus scenario increasing by 60% (40% vs. 100% action completion). There was no statistically significant mean difference in time to action before and after repeat simulation exercise for either simulation scenario. A paired t-test was conducted and we found a statistically significant mean increase of 1.23 in the comfort levels of interns before and after repeat simulation exercise (95% CI [0.47 - 0.84], p < 0.001). CONCLUSIONS: Repeat exposure to simulation improved overall resident critical action completion, however there was no statistically significant improvement in the time to critical action completion. In reviewing this data we can reconcile this, as the more critical actions that are completed, the more time that will take. We were also able to support that repeat simulation exposure increase rate comfort in managing acute patient deterioration.