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Pilot Insitu Simulation on the Adult ICU at UCH


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Multidisciplinary in-situ simulation sessions are a useful way to identify areas for improvement and gaps in training within an existing working ICU, and further cements the ICU team's crisis resource management (CRM) skills in real-time.  This pilot study was to test the feasibility of in-situ simulation sessions within an adult ICU of a busy tertiary teaching hospital.


Each scenario had learning points based on curricula from the Faculty of Intensive Care Medicine, and the Southbank University BSc Course on Professional Practice in Critical Care for Nurses.  Participants in each in-situ session consisted of one senior doctor, one junior doctor, one senior nurse, and one junior nurse.  Each session was facilitated and debriefed by two ICU practice development nurses and another doctor.  CRM questionnaire forms were collected from participants


The in-situ simulation sessions occurred once a month between May and October 2016.  Each session lasted 40 – 60 mins (including. debrief).  20 participant feedback forms were collected.

All participants strongly agreed that:

•All members of the team were appropriately involved and participated in the activity.
•The clinical scenario was realistic.
•This simulation will impact positively on their team working skills.
•This simulation will impact positively on their overall practice.

Participants on average either disagreed or strongly disagreed that:

•The leader maintained appropriate balance between authority and team member participation.
•Team members used closed loop communication at all times.
•Disagreement or conflicts amongst team members were addressed without loss of situation awareness.

All feedback was very supportive of having such in-situ simulation sessions in the ICU.  Some comments extracted below:

“Useful learning points re: task delegation, top communication. Well run, like real life - great, thanks.”

“Loved it! Great learning experience. I really liked having a debrief.”


In-situ simulation sessions within the adult ICU at UCLH received very positive feedback from both participants and staff.  The sessions highlighted the need for better teamwork and communication skills in order to improving CRM skills.  In-situ simulation in the ICU should and will continue on a regular basis.



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