In this paper, we describe the potential of simulation to improve hospital responses to the COVID-19 crisis. We provide tools which can be used to analyse the current needs of the situation, explain how simulation can help to improve responses to the crisis, what the key issues are with integrating simulation into organisations, and what to focus on when conducting simulations. We provide an overview of helpful resources and a collection of scenarios and support for centre-based and in situ simulations.

https://link.springer.com/content/pdf/10.1186/s41077-020-00121-5.pdf

The use of simulation to prepare and improve responses to infectious disease outbreaks like COVID-19: practical tips and resources from Norway, Denmark, and the UK

Real-Time Debriefing After Critical Events: Exploring the Gap Between Principle and Reality.

Healthcare resources have been strained to previously unforeseeable limits as a result of the COVID-19 pandemic of 2020. This has prompted the emergence of critical just-in-time COVID-19 education, including rapid simulation preparedness, evaluation and training across all healthcare sectors. Simulation has been proven to be pivotal for both healthcare provider learning and systems integration in the context of testing and integrating new processes, workflows, and rapid changes to practice (e.g., new cognitive aids, checklists, protocols) and changes to the delivery of clinical care. The individual, team, and systems learnings generated from proactive simulation training is occurring at unprecedented volume and speed in our healthcare system. Establishing a clear process to collect and report simulation outcomes has never been more important for staff and patient safety to reduce preventable harm. Our provincial simulation program in the province of Alberta, Canada (population = 4.37 million; geographic area = 661,848 km2), has rapidly responded to this need by leading the intake, design, development, planning, and co-facilitation of over 400 acute care simulations across our province in both urban and rural Emergency Departments, Intensive Care Units, Operating Rooms, Labor and Delivery Units, Urgent Care Centers, Diagnostic Imaging and In-patient Units over a 5-week period to an estimated 30,000 learners of real frontline team members. Unfortunately, the speed at which the COVID-19 pandemic has emerged in Canada may prevent healthcare sectors in both urban and rural settings to have an opportunity for healthcare teams to participate in just-in-time in situ simulation-based learning prior to a potential surge of COVID-19 patients. Our coordinated approach and infrastructure have enabled organizational learnings and the ability to theme and categorize a mass volume of simulation outcome data, primarily from acute care settings to help all sectors further anticipate and plan. The goal of this paper is to share the unique features and advantages of using a centralized provincial simulation response team, preparedness using learning and systems integration methods, and to share the highest risk and highest frequency outcomes from analyzing a mass volume of COVID-19 simulation data across the largest health authority in Canada.

/pdf/covid-19-pandemic-preparation-using-simulation-for-systems-32hdunf080.pdf

COVID-19 pandemic preparation: using simulation for systems-based learning to prepare the largest healthcare workforce and system in Canada.

Healthcare systems are urged to build facilities that support safe and efficient delivery of care. Literature demonstrates that the built environment impacts patient safety. Design decisions made early in the planning process may introduce flaws into the system, known as latent safety threats (LSTs). Simulation-based clinical systems testing (SbCST) has successfully been incorporated in the post-construction evaluation process in order to identify LSTs prior to patient exposure and promote preparedness, easing the transition into newly built facilities. As the application of simulation in healthcare extends into the realm of process and systems testing, there is a need for a standardized approach by which to conduct SbCST in order to effectively evaluate newly built healthcare facilities. This paper describes a systemic approach by which to conduct SbCST and provides documentation and evaluation tools in order to develop, implement, and evaluate a newly built environment to identify LSTs and system inefficiencies prior to patient exposure.

/pdf/simulation-based-clinical-systems-testing-for-healthcare-10m7xg5c03.pdf

Simulation-based clinical systems testing for healthcare spaces: from intake through implementation.

1Transfusion Medicine, NHS Blood and Transplant, Oxford, UK 2Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK 3Radcliffe Department of Medicine, University of Oxford, and NIHR Oxford Biomedical Research Centre, Oxford, UK 4Transfusion Laboratory Manager, Southampton University Hospitals NHS Foundation Trust, Southampton, UK 5Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK 6NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK 7Department of Haematology, Guy's and St Thomas's Hospital, London, UK 8Transfusion Practitioner, NHS Lanarkshire, University Hospital Wishaw, Wishaw, UK 9National Services Scotland/Scottish National Blood Transfusion, Edinburgh, UK 10Medical director, Serious Hazards of Transfusion, Manchester, UK 11Lead Transfusion Practitioner, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK 12Transfusion Laboratory Manager, Royal Cornwall Hospitals NHS Trust, Truro, UK 13Transfusion Medicine, NHS Blood and Transplant, London, UK 14Barts Health NHS Trust, London, UK 15Blizzard Institute, Queen Mary University of London, London, UK

Haematological management of major haemorrhage: a British Society for Haematology Guideline

Summary StatementModern healthcare organizations strive for continuous improvement in systems and processes to ensure safe, effective, and cost-conscious patient care. However, systems failures and inefficiencies lurk in every organization, often emerging only after patients have experienced harm or

PEARLS for Systems Integration: A Modified PEARLS Framework for Debriefing Systems-Focused Simulations

The healthcare simulation field has no shortage of debriefing options. Some demand considerable skill which serves as a barrier to more widespread implementation. The plus-delta approach to debriefing offers the advantages of conceptual simplicity and ease of implementation. Importantly, plus-delta promotes learners’ capacity for a self-assessment, a skill vital for safe clinical practice and yet a notorious deficiency in professional practice. The plus-delta approach confers the benefits of promoting uptake of debriefing in time-limited settings by educators with both fundamental but also advanced skills, and enhancing essential capacity for critical self-assessment informed by objective performance feedback. In this paper, we describe the role of plus-delta in debriefing, provide guidance for incorporating informed learner self-assessment into debriefings, and highlight four opportunities for improving the art of the plus delta: (a) exploring the big picture vs. specific performance issues, (b) choosing between single vs. double-barreled questions, (c) unpacking positive performance, and (d) managing perception mismatches.

/pdf/embracing-informed-learner-self-assessment-during-debriefing-1s8g30tzl4.pdf

Embracing informed learner self-assessment during debriefing: the art of plus-delta.

### What you need to know

The covid-19 pandemic has renewed focus on debriefings to improve performance among healthcare providers: debriefings help teams learn quickly and manage patients more safely.1234 However, in some circumstances, debriefings may harm more than help. In this article we introduce debriefing and its benefits, highlight the potential consequences when debriefing intentions blur, and offer guidance to navigate shifting debriefing objectives, for example during instances of clinicians’ distress related to patient care.

Team debriefings (also known as after action reviews) are guided meetings during which members discuss, interpret, and learn from recent events.56 Debriefings will typically include both retrospective (eg, collaborative sense making in information-rich and ambiguous environments) and prospective reflection (eg, sustaining positive performance, planning treatments, anticipating problems).57 They foster reflection on clinical practice for the individual and the team. Various debriefing tools and structures are in use, such as TALK (Target, Analysis, Learning, Key Actions),8 PEARLS (Promoting Excellence and Reflective Learning in Simulation),9 and REFLECT (Review the event, Encourage team participation, Focused feedback, Listen to each other, Emphasise key points, Communicate clearly, Transform the future). …

https://www.bmj.com/content/bmj/374/bmj.n2042.full.pdf

Team debriefings in healthcare: aligning intention and impact.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/medu.14564

Changing workplace-based education norms through 'collaborative intentionality'.

CONTEXT Conflict during simulation debriefing can interfere with learning when psychological safety is threatened. Debriefers often feel unprepared to address conflict between learners and the literature does not provide evidence-based guidance within the simulation setting. The purpose of this study was to describe debriefers' approach to mediating interpersonal conflict and explore when, why and how they adopt mediation strategies. METHODS We performed a secondary analysis of qualitative data collected as part of a larger study examining simulation debriefers' approaches to debriefing scenarios with different learner characteristics. For this study, we applied thematic analysis to transcripts from simulated debriefings (n = 10) and the associated pre-simulation (n = 11) and post-simulation (n = 10) interviews that focused on interpersonal conflict between learners. RESULTS Debriefers described struggling with mediating conflict and the importance of self-awareness. Specific mediation strategies included intervening, addressing power relations, reconciling unproductive differences, leveraging different perspectives, circumventing the conflict, and shifting beyond the conflict; each of these strategies encompassed a number of particular skills. Situations that triggered a mediation approach were related to psychological safety, emotional intensity, and opportunities for shared understanding and productive learning. Debriefers applied mediation strategies and skills in a flexible and creative way. CONCLUSIONS The strategies we have described for mediating interpersonal conflict between learners in simulation debriefing align with notions of psychological safety and may be useful in guiding future professional development for simulation educators.

Walter J. Eppich

Papers

PEARLS for Systems Integration: A Modified PEARLS Framework for Debriefing Systems-Focused Simulations

Embracing informed learner self-assessment during debriefing: the art of plus-delta.

Team debriefings in healthcare: aligning intention and impact.

Changing workplace-based education norms through 'collaborative intentionality'.

Approaches to interpersonal conflict in simulation debriefings: A qualitative study.