Editor’s note: Visit the official Western COVID-19 website for the latest campus updates.
* * *
A woman in preterm labour with a confirmed case of COVID-19 arrives at the hospital. From front-entrance screening to delivering the baby and transferring the mother to critical care, health-care providers and front-line staff must carefully manage the situation.
This scenario ‘played out’ recently at London Health Sciences Centre (LHSC). Although instead of testing the team in real time with lives on the line, this one played out as a hospital-wide obstetrics simulation.
“We can close a lot of elective services, but we can’t close OB (obstetrics),” said Surgery professor Dr. Rob Leeper, MD’07. “People still have babies during a pandemic.”
More than 30 Schulich Medicine & Dentistry faculty members have been creating and delivering interprofessional simulation experiences, with the goal of helping health-care providers learn, adapt and prepare for the COVID-19 cases they may encounter.
Led by Obstetrics and Gynaecology professor Dr. Taryn Taylor, MD’10, the interprofessional obstetrics simulation was one of about 50 COVID-19 simulations that have taken place, with more planned.
“Simulation has always been considered an important tool for health-care providers. Highly realistic practice and timely feedback on performance are how individuals and teams improve,” said Dr. Rich Cherry, MD’93, Associate Dean of Learning with Technology & Simulation. “This is even more important in unprecedented times such as this. COVID-19 has changed enormously the way patients need to be cared for and the action of teams responsible for their care.”
Many of the simulations are happening in real clinical environments with real equipment, known as in-situ simulation. Importantly, simulations are being modified in accordance with conservation strategies and policies for personal protective equipment.
“Simulation provides a unique opportunity to bridge the gap between policy, education and practice,” said Taylor, a scientist with the Centre for Education Research & Innovation. “It enables agility, particularly in times of crisis, when policies are changing daily and teamwork is more important than ever.”
Leeper, a trauma surgeon, recently led a comprehensive in-situ trauma simulation for a patient with a gunshot wound who had just crossed the border from the United States and had tested positive for COVID-19. The team included paramedics, nurses, critical care physicians, surgeons, respiratory therapists and X-ray technicians.
During the debriefing phase, the team looked at how much personal protective equipment was affected and how much contamination took place within the trauma bay. The simulation was also observed by staff from the hospital’s cleaning service, who provided important feedback on loss of supplies due to contamination and cleaning time to make the room usable again.
“It was really eye opening,” Leeper said. “From this one scenario, we’re now suggesting changes in air controls and rapid changes to the physical layout of the trauma area, putting up physical barriers to improve our ability to contain aerosolized contagion.”
As an anesthesiologist, Cherry focuses on airway management and intubation for patients with confirmed or suspected COVID-19 – one of the highest-risk moments in care. Initial lessons have included the need for a checklist when donning and doffing personal protective equipment and a second person spotting its removal, as well as adjusting the ergonomics of the operating room to minimize cross-contamination of equipment.
“A pandemic is new for everyone, including health-care providers,” Cherry said. “Simulation lets us observe teams in action, receive their input about how the processes and procedures seem to perform and then rapidly adjust our approaches as needed. Everyone feels far more confident and more at ease if they have the opportunity to practice before a true crisis presents.”
By focusing on changes in behaviour and the physical environment, simulation is improving patient care while also helping health care workers cope with uncertainty and anxiety.
“There are so many things that are beyond our control,” Leeper said. “Simulation gives us the chance to do something, to learn about ourselves and to teach each other. That is really meaningful and empowering at a time like this.”