Table 1 Simulation scenario summary. Expected activities to be completed by the ED teams and embedded eICU staff during the in situ simulation

Act

One

5–10

1. At bedside: full team

2. MD–perform H&P

3. RN/tech–pt on monitor, draw labs, IV start

1. Monitor cart Off

2. Brief introduction to staff when cart turned on for practice (in debrief)

3. Identify ED room number

4. No clinical discussions

Act Two

5–10

1. Telehealth calls bedside RN alerting him/her to BPA firing

2. Team pulls cart to just outside of room, turns it on

3. Clinical introductions

4. Reviews bundle with telehealth, additional orders/interventions

1. Telehealth nurse calls bedside nurse to alert him/her that sepsis BPA has fired on patient

2. Clinical introductions

3. Ask about bundle elements (eICU kept aware via Skype technology²⁴

4. “What sources of infection have you considered?”

5. Recommend 30 cc/kg amount which is approximately 3 L for the 100 kg SP

Act Three

5–10

1. Telehealth notifies bedside RN (or MD) of patient status change–2  hours has elapsed

2. Team returns to room

3. Ensures 30 mL/kg IVF given

4. Starts pressor support

5. Arranges transfer/admission to ICU

6. Focused clinical exam

1. Verify bundle elements as needed

2. Verify classification of patient as septic shock

3. If patient admitted kept in regional ICU, emphasize eICU presence

4. Repeat lactate?