Trauma simulations: Beyond the emergency department
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Wendy Hyatt, BSN, RN, CEN; Alicia Hunter, BSN, RN, CEN, CPEN, TCRN; Steve Clayton, BSN , RN, CEN
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Purpose: The Emergency Department interacts with many other hospital departments when caring for a critically injured patient. Successful communication between these departments can improve patient care and throughput. The purpose of this staff development was to enhance communication between the Emergency Department (ED) and other departments providing care for critically injured trauma patients. Multidepartment simulation training provided an opportunity for staff to interact with multiple departments that care for trauma patients and receive feedback on the process.
Design: The ED initiated simulation training for trauma activations several years ago, but integrating additional key departments was our ultimate goal. Members from all involved departments met to create a scenario that integrated equipment and procedures through the departments. Monthly simulation sessions were offered to provide a small group to facilitator ratio. The facilitators consisted of the trauma nurse coordinator, ED nurse educator, OR nurse educator, and trauma surgeon.
Setting: A 408 bed metropolitan Level 1 trauma center, with over 2600 trauma admissions per year.
Participants/Subjects: The participants included all nurses and emergency medical technicians (EMT’s) in the Emergency Department (n=107), blood bank staff (n=13), nurses and surgical technicians in the operating room (n=74), trauma anesthesia (n=15), and trauma surgery (n=6).
Methods: The training consisted of a pretest, simulation, debriefing and post simulation evaluation. Low-fidelity manikins with moulage injuries were provided for staff during the simulation. Participants were given an initial case presentation via an EMS report and guided through an assessment, interventions and transport to the OR. Debriefing consisted of reviewing massive transfusion protocol, communication with blood bank and pharmacy during massive transfusion, review of any equipment that staff struggled operating, and feedback highlighting what went well and opportunities for improvement.
Results/Outcomes: Overall, there has been an increase in communication with blood bank with early recognition of massive transfusion protocol initiation during the simulation and for patients. All massive transfusion patients seen at our facility in 2017 received plasma products in less than 10 minutes. Interaction with the OR has improved. Trauma anesthesia arrives to all trauma activations, which has helped with continuity of care for trauma patients. There has been an improvement in the use of personnel protective equipment (PPE) in the ED during trauma activations. Initially, the PPE use was below 20%, now the ED uses PPE more than 90% of the time, with the outliers being short notifications. Staff have a better knowledge of the expectations and equipment usage. There has been an improvement in the handoff of the patients between the ED and the OR. Antidotal comments from staff have included positive feedback for physician participation in the process, an increased interest in trauma care, and increased confidence in caring for critically ill trauma patients.
Implications: The success of multidepartment simulation training has encouraged a continuation of this educational opportunity with additional resources. The next year of simulation training will include a moulaged employee with a new scenario to utilize additional equipment within each department. Continued feedback from the staff of each department will be evaluated to ensure simulation training leads to better patient care.
Emergency Nursing 2018. Held at David L. Lawrence Convention Center, Pittsburgh, Pennsylvania, USA
Type | Poster |
Acquisition | Proxy-submission |
Review Type | Abstract Review Only: Reviewed by Event Host |
Format | Text-based Document |
Evidence Level | N/A |
Research Approach | N/A |
Keywords | Trauma; Simulations; Emergency Department |
Name | Emergency Nursing 2018 |
Host | Emergency Nurses Association |
Location | Pittsburgh, Pennsylvania, USA |
Date | 2018 |
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