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COVID-19 and the Evolution of Simulation – IPSSV Keynote Panel Recap

IPSSV Keynote Panel Reflects on Recent Pivots and Long-Term Changes to the Pediatric Simulation Field

IPSSV, held 28 April 2020, featured a keynote panel of experts who work across the simulation spectrum discussing the creative changes they have made in the past weeks due to COVID-19 and the long-term changes the pandemic will have on simulation.

The panelists included:

  • Tensing Maa, MD, FAAP, Medical Director of the Insitu Simulation Program, Nationwide Children’s Hospital
  • Jennifer Reid, MD, Co-Director, Pediatric Emergency Medicine Simulation, Seattle Children’s
  • Stephanie Sudikoff, MD, Director of Simulation, SYN:APSE Center for Learning, Transformation, Innovation, Yale New Haven Hospital
  • Lennox Huang, MD, FAAP, CPE, Chief Medical Officer and Vice President for Academic and Medical Affairs, The Hospital for Sick Children

Brittany Dahlen, MSN, RN, CPN, CCRN-K, Clinical Education Specialist in Simulation at Children’s Minnesota and member of the IPSS2020 Meeting Organizing Committee, moderated the panel. Dahlen began by asking what sim centers and simulationists were doing beyond “traditional sim” to prepare and help with the current pandemic. “The short answer,” Stephanie Sudikoff said, “is anything anyone needed at any given moment in time.” The panelists described establishing training and protocols for parking lot hospitals, developing methods for reprocessing PPE, redefining the intubation process, and more.  

Jennifer Reid stated a shared passion among the IPSSV audience, “I love systems integration in simulation … working with different teams to maximize the tools, teams, processes and environments that help us to provide care for children,” Tensing Maa stated that simulationists have always connected groups that don’t normally work together. In the past few months, communication and cross-functional strategy has been a key to pivoting successfully in their workplaces. The panel was encouraged by other hospital departments having confidence in the simulation team and reaching out to develop new processes and train staff quickly on them.  

The members of the panel represented positions across the spectrum of the simulation environment, and Lennox Huang described the change in directives from hospital management that were necessary to fight COVID-19 successfully. He reflected on timing by relating anecdotes about both a lag in communicating among hospitals city-wide in Toronto and being early to announce travel restrictions for hospital staff. Timing as related to staff availability and attention also played a major role in communications regarding COVID-19 at Sick Kids; their all-staff meeting attendance has jumped to over 1000 people per session. 

Jennifer Reid described the overall feeling since March as intense and uncomfortable; her group is filling a vital need but are doing things that have never been done before. Stephanie Sudikoff agreed, “Every aspect of this situation is so much more fueled than any I’ve experienced before [in volume and duration].” Sudikoff also described the need for an expansive debrief on the “rapid response sim” practices that have been adopted as the world moves into the post-COVID environment. In addition, COVID-19 has affected the mental health of frontline healthcare professionals by creating moral distress. In many cases, healthcare workers are relaying messages from family to severely ill patients, and the distance and precautions they have to maintain reduces their ability to offer comfort. Intentional debriefing should be planned for staff members experiencing these situations.

Simulation has been integral to transforming the way healthcare is provided in the past few months, and the speed for development, testing and introduction of processes has led to many innovations that will remain. There has been a change in the very definition of simulation, but what hasn’t changed is the fundamental benefit of preparation through simulation. How will the now acceptable standards of quick testing, debriefing, and pivoting leave a legacy on simulation?  IPSS members will now begin to answer these questions.

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I am a UK-trained Neonatologist working in Starship NICU in Auckland, New Zealand. I am a member of the Douglas Starship Simulation faculty and lead the simulation programmer in NICU. My key simulation interests include education, communication and patient safety. I have been an active member of IPSS since 2011, member of the Education Committee since 2012, am a past Co-Chair of the Education Committee (2017-2018) and a current member of the Board of Directors. In collaboration with others, I established the IPSS-INSPIRE Fellowship in 2018 and am on the working group leading this initiative. My vision for IPSS is to continue to support collaborative knowledge sharing and research development in the pediatric and perinatal simulation community. My wish for IPSS is to see an increasing number of non-physician members and to support and develop the ability of those still at the early stage of simulation.

 

 

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Dr. Carl Horsley

Intensivist, Counties Manukau Health, Auckland, New Zealand

Clinical Lead for Patient Safety, Health Quality and Safety Commission, New Zealand

Dr. Carl Horsley dual trained in Emergency Medicine and Intensive Care, and works clinically in the Critical Care Complex of Middlemore Hospital in Auckland, New Zealand. As part of his work there, he developed an in-situ simulation program specifically focused on building the adaptive capacity of the ICU team. This was put to the test in the Whakaari volcanic eruption with Middlemore being the national burns centre responding to a mass casualty event.

Carl is currently completing an MSc in Human Factors and System Safety at Lund University, Sweden with a thesis focusing on the sociology of safety.  He is also part of the Resilient Healthcare Society which is an international collaboration exploring the implications of resilience engineering in healthcare. As Clinical Lead for Patient Safety at the Health Quality Safety Commission, Carl is also involved in developing innovative approaches that support “work-as-done” by frontline to improve both patient care and staff wellbeing. He has published several book chapters on resilient healthcare and presented widely on the topic.

 

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Dr. Andrew Petrosoniak

Emergency Physician & Trauma Team Leader, Assistant Professor

St. Michael’s Hospital and University of Toronto

Following an unsuccessful career as an intramural basketball player, Dr. Petrosoniak now works as an emergency physician and trauma team leader at St. Michael’s Hospital. He’s an assistant professor at the University of Toronto and an associate scientist at the Li Ka Shing Knowledge Institute. He’s the lead for translational simulation at St. Michael’s Hospital which involves the application of simulation techniques to identify issues and support the design of solutions related to healthcare delivery and improving health service outcomes.

More accurately, he seeks to reduce the number of F-bombs by providers linked to poor system/space design in healthcare. He also applies this work in the private sector as the co-founder of Advanced Performance Healthcare Design, a design and consulting firm that uses multi-modal simulation techniques to inform the design of clinical infrastructure, equipment and high performing teams.

 

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