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Table 2 Summary of the emergency on-call physiotherapy scenario

From: Using video-reflexive ethnography and simulation-based education to explore patient management and error recognition by pre-registration physiotherapists

The scenario exposes the pre-registration physiotherapy students to an adult medical patient whose condition has recently started to deteriorate. The patient was admitted to the Medical Ward via Accident and Emergency. An emergency on-call physiotherapy assessment is requested by the staff nurse.
The learning objectives were to:
 • Demonstrate management of an acutely deteriorating medical in-patient
 • Implement appropriate physiotherapy intervention
 • Adhere to safe working practices including health and safety, moving and handling and infection control
 • Recognise universal precautions/unsafe practice and take appropriate action
 • Provide an structured handover
Scaffolding: The scenario built on prior acute illness management and cardio-respiratory knowledge and skills embedded throughout the pre-registration physiotherapy curriculum. Antecedent cues included temporal (realistic physiological timing of responses to intervention), interpersonal cues (verbal prompts outlined in the simulated patient and healthcare assistant role profiles) and internal cues (manikin responses). Verbal, visual monitor display and written cues were provided to enable learners to discriminate conditions and prompt the desired consequence in a scenario (e.g. normalisation of physiological status in response to appropriate physiotherapy intervention). Participants were encouraged to ‘think aloud’ during the scenario.
Role allocation and orientation: Randomization of participants to the role of the emergency on-call physiotherapists or healthcare assistant. All participants were then oriented to the simulation-based learning environment and equipment prior to the pre-brief.
Pre-brief synopsis: Mr. Williams is a 61-year-old male who was admitted to the hospital 25 days ago. His admission diagnosis was multiple sclerosis and a recurrent urinary tract infection. The previous physiotherapy assessment findings indicate that he has low tone in his upper, lower limbs and thorax. He has restrictive thoracic movement in particular extension. Recommendations for moving and handling include using a slide sheet and hoisting from the bed to the chair or wheelchair. Assisted drinking is required and prompting Mr. Williams to cough post-swallow. The staff nurse reports that the patient is currently very tired, has a weak cough and has been sleepy since yesterday. He has become quite chesty since last night, when he had a drink of tea and thickened soup. An emergency on-call physiotherapy assessment is requested by the staff nurse.
State 1 (initial assessment): The healthcare assistant is seated in the side room reviewing the patient’s notes. The patient’s physiological condition starts to deteriorate (in real time) as the physiotherapist enters the simulated side room. The physiotherapist is expected to complete an initial respiratory physiotherapy assessment.
State 2 (physiotherapy intervention): The physiotherapist is expected to implement appropriate physiotherapy intervention based on clinically reasoned decisions. This included requesting a review and increase in oxygen therapy, repositioning the patient to optimise ventilation perfusion matching and selecting and administering appropriate chest physiotherapy intervention.
State 3 (reassessment and handover): The physiotherapist is expected to reassess the patient’s status and provide a structured handover to the nurse/healthcare assistant.