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{ "pk": 13919, "title": "In-situ Simulation Use for Rapid Implementation and Process Improvement of COVID-19 Airway Management", "subtitle": null, "abstract": "Introduction: \nThe coronavirus disease 2019 (COVID-19) pandemic presents unique challenges to frontline healthcare workers. In order to safely care for patients new processes, such as a plan for the airway management of a patient with COVID-19, must be implemented and disseminated in a rapid fashion. The use of in-situ simulation has been used to assist in latent problem identification as part of a Plan-Do-Study-Act cycle. Additionally, simulation is an effective means for training teams to perform high-risk procedures before engaging in the actual procedure. This educational advance seeks to use and study in-situ simulation as a means to rapidly implement a process for airway management in patients with COVID-19.\nMethods:\n Using an airway algorithm developed by the authors, we designed an in-situ simulation scenario to train physicians, nurses, and respiratory therapists in best practices for airway management of patients with COVID-19. Physician participants were surveyed using a five-point Likert scale with regard to their comfort level with various aspects of the airway algorithm both before and after the simulation in a retrospective fashion. Additionally, we obtained feedback from all participants and used it to refine the airway algorithm.\nResults:\n Over a two-week period, 93 physicians participated in the simulation. We received 81 responses to the survey (87%), which showed that the average level of comfort with personal protective equipment procedures increased significantly from 2.94 (95% confidence interval, 2.71-3.17) to 4.36 (4.24-4.48), a difference of 1.42 (1.20-1.63, p < 0.001). There was a significant increase in average comfort level in understanding the physician role with scores increasing from 3.51 (3.26-3.77) to 4.55 (2.71-3.17), a difference of 1.04 (0.82-1.25, p < 0.001). There was also increased comfort in performing procedural tasks such as intubation, from 3.08 (2.80-3.35) to 4.38 (4.23-4.52) after the simulation, a difference of 1.30 points (1.06-1.54, p < 0.001). Feedback from the participants also led to refinement of the airway algorithm.\nConclusion: \nWe successfully implemented a new airway management guideline for patients with suspected COVID-19. In-situ simulation is an essential tool for both dissemination and onboarding, as well as process improvement, in the context of an epidemic or pandemic.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Simulation, Emergency Medicine, COVID-19" } ], "section": "Endemic Infections", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/7sh742q0", "frozenauthors": [ { "first_name": "Brendan", "middle_name": "W.", "last_name": "Munzer", "name_suffix": "", "institution": "Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan", "department": "None" }, { "first_name": "Benjamin", "middle_name": "S.", "last_name": "Bassin", "name_suffix": "", "institution": "Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan\nMichigan Center for Integrative Research in Critical Care, Ann Arbor, Michigan", "department": "None" }, { "first_name": "William", "middle_name": "J.", "last_name": "Peterson", "name_suffix": "", "institution": "Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan", "department": "None" }, { "first_name": "Ryan", "middle_name": "V.", "last_name": "Tucker", "name_suffix": "", "institution": "Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan", "department": "None" }, { "first_name": "Jessica", "middle_name": "", "last_name": "Doan", "name_suffix": "", "institution": "Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan", "department": "None" }, { "first_name": "Carrie", "middle_name": "", "last_name": "Harvey", "name_suffix": "", "institution": "Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan", "department": "None" }, { "first_name": "Nana", "middle_name": "", "last_name": "Sefa", "name_suffix": "", "institution": "Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan", "department": "None" }, { "first_name": "Cindy", "middle_name": "H.", "last_name": "Hsu", "name_suffix": "", "institution": "Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan\nMichigan Center for Integrative Research in Critical Care, Ann Arbor, Michigan", "department": "None" } ], "date_submitted": "2020-05-13T05:42:50+10:00", "date_accepted": "2020-05-13T05:42:50+10:00", "date_published": "2020-11-04T19:00:00+11:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/13919/galley/7234/download/" } ] }