Chest Trauma in the ED: Focus on Teamwork With in-situ Simulation

Abstract

Abstract Introduction Team skills are introduced in the classroom, then adapted and developed outside of the classroom. To further develop these skills, we need practice in the clinical environment. We can practice during the care of patients, but should also practice during simulations. We developed this scenario to practice team skills during simulations in the emergency department (ED). Methods This scenario provides an opportunity to develop key team and clinical skills and involves a 23-year-old male patient suffering from a gunshot wound to the right chest. The patient arrives intubated, with a report of stable vital signs in the field but hypotensive upon arrival to the ED. During the simulation, learners are expected to manage acute resuscitation of trauma, recognize of need for general surgery consult, recognize and treat massive hemothorax, and exhibit effective team management and communication. This resource includes coaching tips and debriefing tips to help the teams focus on communication and teamwork behaviors that improve patient care. Results This in-situ scenario was performed 16 times over 9 months, with a total of 24 ED resident physicians, 30 medical students, 16 general surgery residents, 28 ED nurses, as well as respiratory therapists and radiology technicians. Participants greatly appreciated the opportunity to do in-situ simulation, and rated this scenario 4.5 on a 5-point Likert scale. Discussion This in-situ scenario was performed with a portable high-fidelity manikin in the ED during the morning hours, a statistically quieter time of the day in the ED and we staggered the timing to capture both night shift and day shift team members. The benefits of in-situ simulation during clinical time eliminated the need to juggle schedules and arrange out-of-shift time for this training. Additionally, having the simulation done in a familiar clinical environment enhanced the reality of the scenario and the comfort of the participants.

Keywords

• Trauma
• Teamwork
• Resuscitation
• Hypotension
• Hemothorax
• Chest Tube