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Table 1 Scenario objectives and roles

From: The effects of active (hot-seat) versus observer roles during simulation-based training on stress levels and non-technical performance: a randomized trial

Scenario Synopsis Learning Objectives Role
    Observer group Hot-seat group
1 6-month-old infant in PACU with anaphylaxis
The patient was in PACU following incision and drainage of an abscess and received antibiotics just prior to arrival.
The PACU nurses noticed that the infant was tachycardic and in respiratory distress. The trainee was asked to assess the patient.
Expected actions: Obtain a pertinent history, perform a physical examination (bilateral rhonchi, HR 160, BP 65/40), and call a senior for help. Institute appropriate management with the team (oxygen, fluids, adrenaline).
If treatment is delayed for 10 min, the patient would have a cardiac arrest.
Expected actions: Perform resuscitation with the team according to the PALS algorithm. Arrange for ICU admission.
Technical:
Recognition and management of anaphylaxis
Non-technical:
Calling for help early
Communication
Read back, feedback
Situational awareness when patient deteriorates
Teamwork and task management during resuscitation
Observer Hot-seat
2 8-month-old infant in pre-operative area with septic shock
The infant was scheduled for diagnostic laparoscopy. He was febrile and had not been feeding well for 2 days. His mother (confederate) was present and very anxious. She became disruptive as the patient started grunting.
Expected actions: Obtain a pertinent history from the mother, assess and manage the patient, and delegate a second nurse to attend to the mother.
Work with the nurses to administer oxygen, call a senior for help, institute appropriate monitoring, and alert the surgeon.
The patient was tachycardic and hypotensive. If no isotonic fluid was administered by 12 min, the patient would deteriorate into cardiac arrest (PEA).
Expected actions: Perform resuscitation with the team according to the PALS algorithm.
Technical:
Recognition and management of septic shock, appropriate fluids, inotropes
Non-technical:
History-taking
Appropriate management of caregiver
Calling for help early
Effective communication with anaesthesia nurses, surgeon, and team
Observer Hot-seat
3 9-month-old infant in PACU with airway obstruction
The infant had just undergone a cleft palate repair and was extubated awake. The PACU nurse noticed that the infant had ‘noisy breathing’ and called the trainee to assess him.
The infant was initially coughing but subsequently developed stridor, suprasternal retractions. SpO2 90%, decreasing steadily.
Expected actions: Recognize upper airway obstruction and institute appropriate management (exclude foreign body, suction, oxygen, CPAP). Call a senior for help and review the anaesthesia chart. Attempt direct laryngoscopy.
Sedation and succinylcholine was needed as the infant coughed on attempted laryngoscopy. The i.v. cannula was found to have extravasated, and a decision had to be made whether to attempt resinsertion of the i.v., give i.m. succinylcholine, or call for more help.
Direct laryngoscopy would reveal the retained throat pack, but the patient would develop a brief period of profound hypoxia and bradycardia (HR 30) which would be reversed by oxygenation and a brief period of chest compressions (30 s).
Expected actions: Ensure adequate oxygenation and institute brief period of chest compressions if necessary. Communicate with senior anaesthetist and surgeon regarding the retained throat pack and arrange for post-operative admission.
Technical:
Recognition of airway obstruction in an infant
Differential diagnoses and management.
Non-technical:
Calling for help early
Decision-making: identifying options, balancing risks, reevaluating
Situational awareness when patient develops profound bradycardia
Communication with nurses and surgeon
Effective resource management and teamwork during resuscitation
Hot-seat Hot-seat