Skip to main content

Table 4 Practical considerations for the conduct of simulation sessions

From: 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

General aspects• Comply with limitations of bringing people into the same physical location in the current situation. Consider e-learning and remote connection possibilities.
• Strongly encourage participants to review the organisation’s up-to-date infectious control materials (e-learning, videos, etc.) before attendance.
• Beware not to introduce risks or contagions into the simulation area, especially during pandemics (but also in non-pandemic situations) [12].
 o Discard/remove training equipment, do not re-use clothes for training, ensure replacement of correct equipment in clinical areas, label training equipment as such clearly, etc.
Briefing• Clarify routines to participants, e.g. personal protection equipment (PPE), staff placement, equipment to use, clean/non-clean staff/areas. Use the time in the briefing to clearly go through these aspects, so participants may practice them in simulation.
• Highlight the importance of coordinating placement of personnel during high risk aerosol-generating procedures:
 o Team leader takes her/his place vocally and physically in briefing, thereby establishing leadership.
 o Team leader establishes explicit ground rules with team for communication in general with PPE and good use of time-outs prior to invasive/risky procedures.
If using air-isolation room for infectious control, ensure staff knows how to use this, and coordination of communication is practiced if these are new skills.
Scenario• Wear PPE (if you can use it) or mock-PPE for the simulation. This reinforces the need for teams to communicate very clearly as PPE disrupts concurrent lip reading and the understanding of facial expressions; additionally, speech audibility tends to be slightly reduced. (Video recordings might make this obvious.)
• Most hospitals must conserve use of PPE for actual clinical patients: devise mock-equipment that can stimulate learning and try not to use precious PPE resources if possible, e.g. write “FFP3” onto surgical masks or use masks participants were fit-tested with. Use different coloured aprons to represent different types of gowns.
• Be very aware of potential risks of spreading the infection in case of re-use of equipment (prevent re-use where this risk exists).
• If observing infection control breaches, consider time-out procedures for immediate feedback; ask participants to observe, ascertain, and correct breach, then continue.
Debriefing• Respect that most healthcare professionals are interested in correct PPE and infectious disease control activities during a pandemic. Do not forget other important human-factors issues, such as teamwork, situational awareness, and communication that might also be related to safe care [44, 45].
• Topics with likely high interest:
 o Task collaboration between “clean” and “non-clean” personnel.
 o Time-outs and clearing personnel before interventions.
 o Communication with PPE.
 o Infection control during handover and transport.
 o Self-protection and other technical questions (participants tend to have many of these and want robust answers)
• Either follow up personally or brief other people in the organisation about critical un-resolved questions and establish feedback relevant loops
• Be prepared to adjust/re-adjust to changing protocols.
• Consider the timing of the debrief. Are participants going to stay for the whole session, or may they be called back to clinical service? If so, consider options such as stop-start scenario and running commentary to highlight positive and problematic behaviours. You can still do a post-simulation debrief if time allows.
Logistics• Prior to in situ training, check the feasibility for simulation onsite (remember to check electricity outlets and other material). Be as independent as you can by bringing all the equipment needed, thereby minimising the strain on the departments in which you simulate. If your hospital is working under a major incident command structure (like it would be in the UK), you will have to get appropriate clearance (e.g. silver or gold command level authorization in the UK).
• Have a clear checklist for the equipment and requirements that you cannot bring yourself and what you expect the department in which you simulate to provide (e.g. access codes for the Wi-Fi)
• Consider involving pre-graduate students into your operations and logistics, as they are able to absorb some of the workload [46].