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Table 1 Participant perceptions of Trauma Simulations

From: Improving the relational aspects of trauma care through translational simulation

Theme Subtheme Representative examples
Behaviour, process and systems change
  Communication & teamwork behaviours Good to practice complex competing head injury with shock and other organ/systems and sort out priorities and to further develop improved ways of managing multiple simultaneous tasks including blood product resuscitation.
Creation of realistic Sim gives the opportunity to develop and standardise handover and assessment/interventions procedures in a realistic manner.
High value in terms of team training, process training and exercise of new protocols, exercise of new communication practices (handover in OT of red blanket patient), quite high fidelity training even of technical skills!
  Role allocation and team structures I [now] try to get everyone’s name at the start of the day and make an effort to illustrate the whole teams concerns about a case before we start
More focus on a standardised process, clearer communication, avoiding “loading up” the TTL.
I have become more familiar with the actual roles and workload of various other parties/individuals in the trauma team.
Delegating a task to a micro team and allowing their full autonomy unless there is an issue (airway/transfusion protocol)
  Leadership (Now) very clearly signposting verbally to the team the most important priority setting verbal times for when things need to happen by—“It is 3 O’clock now, we are aiming to be on our way to CT at 3:10”.
Increased awareness of the value of “stepping back” as a team leader without hands on the patient.
  Process review and improvement Provided the opportunity to think through the processes and also where to go and who to talk to etc. especially when we took pt. straight the theatre which is somewhere I have not been before. We have introduced procedures such as the pre and post.
Intubation checklist, and had the opportunity to try different variations of this. We also have had the opportunity to fine tune procedures and test communication styles.
We have been provided access to the Resus camera’s so we can monitor progress of the patients arrival to CT.
Culture and relationships
  Interdisciplinary role understanding Very effective in highlighting the subtle differences in priorities between the ED, Surgical, ICU and Anaesthetic teams when managing a patient.
An opportunity to practice, the focus on processes and communications, getting to know the other team members in a learning environment, getting a better sense of the roles of others and the pressures/challenges that involves (esp. nursing).
Chance to gauge other people’s opinion and point of view of the trauma. Great opportunity to promote dialogue amongst different specialties.
There is a big role for ED staff to orientate the specialist teams and define anticipated tasks and where their help is required.
  Team building I think the real value is getting to know our colleagues from other departments outside of a real life stressful situation. That familiarity is then incredibly helpful when faced with a real trauma.
There is a culture of mutual respect between the specialty teams involved which is fostered by the debrief and carries over into the real world.
Mostly it promotes team-building, both in-house and between specialties.
My practice remains the same, though I have noticed inter-departmental relationships are better as a result of the sims.
Personal and team learning
  Personal and team reflection process and habit Because we practise together becoming like a team that is being coached. We get to know each other, give space and gain understanding of each other’s roles, and are informed and reminded of our common goals. (time to protect airway, time to OT) and common challenges (safety in CT scanner with unstable patient).
Often are we make some solid learning points and debrief areas of improvement. I think everyone is getting better at useful discussion and not blame.
Made me look at my communication style and adjust how I interacted with others in a real situation.
Definitely helps to reflect on good/bad things and work towards solutions as a group.
  Personal learning, confidence & motivation My own personal learning of the systems down in ED, making connections to faces, and being able to possibly improve on areas in anaesthetic related care in another’s department.
I have had sim cases that I have not dealt with before in real cases. This sparks an interest in the situation and encourages adaption to whatever scenario may present.
Help organise and focus my own thinking and processing of information on how we manage the patient journey.
I find that the debrief afterwards is always such an goldmine for the technical points but also for the non-technical skills in thinking of the things that could go wrong before they do.
We all get nervous and it’s a great way of stepping through situations that you could possibly be faced with hours after the sim, it helps you prepare mentally.
Makes me brush up on certain detailed knowledge that perhaps I did not have at my instant recall - invites me to continue to read around cases and improve.
  Translation to practice I have become more familiar with equipment in the emergency department and am therefore less likely to rely on equipment I bring from my own environment.
I have found that those who participate in the sims incorporate the lessons into their practice, especially around communication and collaborative decision making.
I have noticed improvements over the years because of this both in my handovers and the reception of them. Knowing what the ED staff needs allows me to better streamline and deliver handovers to them.
Many (changes). I communicate in resus differently now. I advocate for names on gowns. The TS nursing staff try to take on the transfusion role in resus which is new and where we are most useful.
We have changed processes, moved to a focused hands off QAS handover, recognised and adapted communication issues and fears in foreign environments. Noted strengths in staff not previously recognised such as planning and predictive actions taken by experienced porterage staff.
The impact of the simulation experience
  Perceptions of realism related to stress/emotional fidelity, and team/task fidelity It felt legitimate and people seemed to take it very seriously—the more complex and stressful the pt. the more the team treats it as a real situation.
High level of realism with elevating noise levels, multiple individuals involved and complex disposition planning.
The in situ simulation is very realistic to the real situations. They are usually noisy events with lots of people you probably have not met before. They do re-create the real world issues we face with managing the team, trying to not lose momentum etc.
Very well! Staff exhibited many of the same emotions and work stresses associated with real cases. Many minor issues arose in the Sim that replicated itself in actual cases.
Pretty similar to DAY TIME traumas. Totally different to night time traumas.
  Experimentation/learning supported by lack of perceived risk to patients More time to see process from others’ perspectives; non-stressful and non-threatening environment which encourages learning.
Yes—debriefing encourages different departments to communicate in ways that cannot occur when a sick pt. still needs active management in a structured and led safe space.
  Facilitated debrief creating safe space for discussion/disclosure/reflection Often if you are in the sim you may have a biased perspective, i.e. you think you did worse or better than you actually did so debrief helps to get outside perspective on performance and if any improvement could be present.
Good to get other speciality feedback from a non Ed perspective as we do not often get to discuss these issues in a constructive environment.
Often walk away feeling less “judged” than I always anticipate.
I find the experience empowering, as you are afforded the opportunity to discuss things in a calmer environment. You can receive positive feedback which makes you feel good. It’s not an environment of “name and shame”. We are lucky enough to have a decent pool of people who run and debrief the scenarios.
Makes it feel safe to participate again because I feel very safe with debriefers. They are very good at pointing out how we can improve as a team and making common goals more clearly visible.