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Table 1 Description of the UHT-SP led initiatives in response to major requests from organizational senior leadership

From: Lessons learned in preparing for and responding to the early stages of the COVID-19 pandemic: one simulation’s program experience adapting to the new normal

Clinical target group/locationOverall objective(s)Simulation and/or technology-enhanced modalityImpacts
Organizational request: how can UHT-SP test new spaces and new models of care for COVID-19 patients?
All healthcare professionals screening COVID-19 patients.To design a COVID-19 Assessment and Screening Centre with optimized physical spacing, staffing allocation, and patient flowIterative process using prototypes and mock-ups to guide construction of physical space, simulations with staff and standardized patients, iterative development of signage placement and designFinalized data-informed protocols, signage, and workflows prior to the opening of the screening center
All critical care clinicians, as well as clinicians with potential to be redeployed to work in the ICUTo evaluate a proposed model of care, from primary care to team-based care, in anticipation of increased number of ICU patients and shortage of critical care trained cliniciansVideoconferencing to present the proposed model of care, multiple tabletop simulations using videoconference platform, in-person tabletop simulations for select groups, in-person in situ simulation in critical care settingDerived themes from tabletop simulation discussions and synthesized into an executive summary about the model of care for professional practice teams and senior leadership
Identified limitations of tabletop simulation led clinician participants to ask for the model to be piloted in actual ICUs with COVID-19 positive patients
Organizational request: how can UHT-SP ensure our individuals and teams follow the safest clinical protocols and procedures?
Healthcare professionals and trainees working on various clinical units; each listed below with one example of each unit’s objectives.To develop and refine hospital-based protocols in situ, and to feedforward information to leadership for command center decision-makingRapid cycle in situ simulation scenarios focused on usability testing, identifying latent safety threats, and optimizing signage/visual aids; process was coupled with mock-ups and tabletop simulationsIdentified and addressed gaps in new and pre-existing hospital policies and protocols
Refined and finalized all policies and checklists/visual aids to guide further training to prepare for patient surges.
Early simulation activities in the ICU sparked and cemented collaborations between UHT-SP, the IPAC team, and clinical units
Emergency department (ED)Sample objective: to optimize the escalation protocol for transporting a COVID-19 positive patient from the ED to the ICU
Intensive care unit (ICU)Sample objective: to modify standard operating procedures to ensure they account for unique issues presented by COVID-19, including PPE use, novel specific COVID-19 equipment bundles, and “protected” procedures
Operating room (ORs)Sample objective: to translate the pre-existing PPE protocols developed by the IPAC team for non-OR areas to meet the needs of all perioperative staff, while maintaining IPAC established standards
Labor and delivery (L&D) ORSample objective: to test and iteratively refine the policies associated with L&D team care for a laboring mom with a positive COVID-19 diagnosis
Inpatient medical unitsSample objective: to implement protected code blue protocols established in the ICU on the acute care inpatient medical units, to determine how best to refine protocols in those settings
Hospital morgueSample objective: to test and modify the protocols for transferring deceased COVID-19 positive patients from units to morgue and from morgue to funeral homes to inform the organization’s new expedited death response policy
Organizational request: how can UHT-SP ensure healthcare professionals have the minimal competence (and confidence) to practice safely?
Healthcare professionals, support staff, and trainees in the ED, ICU, ORs, L&D OR, inpatient medical units, and the morgueTo translate refined COVID-19 policies and protocols into training materials
To train all healthcare professionals, repetitively where possible, to apply refined protocols to their general practices, as well as to specific procedures
In situ simulation scenarios in the early phase of protocol development; shifted to center-based simulation to run standardized scenarios for larger groups of healthcare professionalsStaff reported feeling less anxious, including an increased sense of safety and confidence following training.
Practicing professionals, who typically view simulation as an educational tool for their trainees only, attended sessions in overwhelming numbers and their anecdotes suggest more extensive participation in future simulations.
First responders at all three sitesTo ensure all first responders’ basic life support (BLS) skills meet the hospital network’s standard
To expose learners to COVID-19 considerations, especially PPE use
Centralized curriculum, adapted to each site’s requirements in classroom or center-based setting; task trainers for protected BLS skills using “PPE buddy” approachUpskilled approximately 180 participants
Staff reported refresher helped reorganize their skills, and improved confidence they could stay safe and protected in their roles.
Registered nurses (RNs) across departmentsTo prepare non-critical care RNs to transition to work on COVID-19 ICUs via upskilling in, for example, aerosol-generating procedural skillsCenter-based simulation, including part-task trainers, role play, and theater-based scenarios; train-the-trainer approach used to scale up the training from the original cohort to other nursing staff membersCompleted training with 90 RNs, with most reporting reduced anxiety, increased confidence in providing safe care
Simulation educators and trained RNs facilitators provided training for over 90 additional RN colleagues.