Imagine this difficult scenario. An infant with suspected COVID-19 arrives at a Vancouver Island emergency department (ED). The baby is having trouble breathing and requires intubation – insertion of a breathing tube - before being transported to the pediatric intensive care unit (ICU) in another area of the hospital. This is one of several scenarios related to COVID-19 that Island Health has been working hard to prepare for through the use of simulations.
“When we started hearing about COVID-19, we began to ask ourselves ‘If someone presents at an emergency room, how do we protect other patients, our teams and look after the patient?’ That’s where simulations play such an important role,” says Anna Macdonald, Manager, Centre for Interprofessional Clinical Simulation Learning at Island Health.
Simulation is a technique used frequently in healthcare training, particularly during high risk situations like COVID-19 that clinicians don’t encounter often. It allows healthcare teams to practice how they can respond to a patient in different situations.
The simulation or ‘sim’ centre at the Royal Jubilee Hospital is a collaboration with the University of British Columbia Faculty of Medicine Island Medical Program and the University of Victoria Faculty of Human and Social Development. The sim team helps to support simulation activities across Vancouver Island in a variety of healthcare areas including acute care, community care and long-term care, such as through the use of life-like mannequins where teams can transport ‘patients’ from an ambulance to an ED, intubate the patient, transfer them to ICU and practice other skills and procedures.
“Simulations help to empower teams, build their confidence, prepare the system, identify gaps and work to remove those gaps long before COVID hits the hospitals,” says Macdonald. “Teams learn what and what not to do so when a real patient comes in, things can go smoothly because they have practiced in advance.”
The COVID simulations have presented some interesting challenges for healthcare providers. For example, doctors, nurses and others who care for COVID patients often work in rooms where doors must remain closed at all times. How do you communicate with someone who is standing outside the room when everyone is wearing a mask and a visor and no one can hear one another?
Teams working through simulations have addressed those issues in a number of ways including using baby monitors, placing cell phones on speakerphone and sealing them in plastic bags, or writing on whiteboards.
“Solutions are unique to each area – some things work and others don’t but simulation allows teams to practice without placing patients at risk,” says Laura MacKinnon, Clinical Nurse Educator, Centre for Interprofessional Clinical Simulation Learning.
Dr. Shuen King, an anesthesiologist and simulation lead for the department of anesthesiology at Victoria General Hospital (VGH) and Royal Jubilee Hospital (RJH) says she and her colleagues have focused on two simulation scenarios – dealing with COVID patients coming to the OR for surgery, and assembling a COVID airway and resuscitation team that delivers patients to the OR, intubates them and takes them to the ICU. They’ve practiced both scenarios dozens of times.
”A team of experts isn’t the same as an expert team. We’ve been working to train that expert team through simulation,” says Dr. King. “When you bring people together, there are non-technical skills and considerations needed for that team to function to the best of its ability. Simulation has allowed us to build that into our training. It’s also given us the opportunity to test out our processes, some of which were new, and identify hidden threats so we could address them before we encountered a real patient.”
The pediatric COVID-19 scenario is one of several that VGH and RJH emergency room physician Dr. Brian Farrell has been practicing over the last several months. He says that lessons learned from COVID outbreaks in China, Italy and New York have allowed Vancouver Island healthcare providers to ramp up their simulation practices in advance.
“The precautions we are taking during COVID are pretty extraordinary. It’s not often we have to use airborne precautions in the hospital so it’s helpful to be able to practice safely,” says Dr. Farrell. “We already recognize the value of simulation and in unusual circumstances like COVID, simulation becomes even more valuable.”
In addition to supporting our healthcare teams in their simulation practices, the Island Health sim team has worked with colleagues across the province, including the British Columbia Simulation Network, to develop a COVID-19 simulation guide.
“Typically we support simulations in person, but we can’t do that right now due to physical distancing. Instead, we created a how-to guide as a tool to help teams develop a simulation experience with us supporting them from a distance,” says MacKinnon. “We provide the guide as a first step after someone contacts us about helping them to set up a sim.”
The resource, originally aimed at a provincial audience, has since been shared by Simulation Canada and promoted widely online and by word of mouth. At last count, the guide has been downloaded 378 times in 32 countries.
“It’s amazing to know that colleagues in the UK, Australia, parts of Europe, and Asia have been accessing the Canadian site and using our guide,” says Macdonald. “We are working to gather feedback from users to see how the guide has benefited their simulation practices.”
Island Health teams are heralding the effectiveness of the COVID-19 simulations and the efforts of sim lab staff in helping them to protect staff and patients during this unprecedented time.
“They are a fantastic resource,” says Dr. Shuen King. “There is a lot of stress and anxiety around COVID for healthcare providers and one of the fringe benefits of our simulations is the incredible effect they’ve had on morale. It’s given us an opportunity to be really comfortable in the processes and protocols we’ve developed by working through each sim exercise.”
Cowichan/South Island media inquiries: