In homage to How-I-Sim, this is guide to why i decided to start doing in situ sim (ISS), how I started and next close goals.
I had been working in a rural GP setting with lots of oncall, generally not too sick but the occasional poorly patient. This was still solo GP work however, oncall with one or two nurses. Since leaving internship I had not been exposed to any simulation work and although had been away for weekend courses (ATLS/APLA/ELS), the nurses don’t attend and equipment and work-flow are different when you return to your shop.
Now working in a larger group practice I wanted to improve our team approach to emergencies in the practice, rare but significant for patient, practice and provider.
I enrolled in the Australian Government sponsored NHET-Sim program and completed part one and two of their online course. I drank deeply from the FOAMed out there on the use of Sim – tweets, websites and podcasts.
I purchased a Laerdal Little-Annie and a AED trainer (second hand – no budgets for GP sim!) and drafted my first scenarios.
I presented at the practice meeting that had undertaken some training and wanted to improve the practices’ ability to respond in a crisis with a focus also on registrar training and mandatory CPR training for reception staff.
I wanted involvement of all, the GP’s, practice nurse and reception staff as the difference I wanted to create was the team response to a crisis – common in anaesthetic, pre-hospital or emergency medicine, rarer in general practice.
Timing and duration were two factors important to the other GP’s, there is not budgeted or remunerated training time so time not consulting is money lost. I suggested 30minute sessions in total – a typed preamble emailed the weeks before, a five minute prebrief, ten minute simulation and fifteen minute debrief. This is the example of a preamble I emailed particpants for pre-reading on quality CPR.
Simulations were timetabled in the first 30minutes of the working day for minimum patient and staff disruption, on a day I was not working so I could come in, set up and then tidy up in my room while the practice went on with the day. I do not see there is a role for unannounced or guerilla sim in private general practice. Likewise I believe the task needs to be very clear and with my short time frame, one or two tasks only – quality CPR, use the AED, finish or recognise anaphalxysis, give appropriate dose of adrenaline, finish.
It took me six months to get from starting the online training to running my first simulation for the practice however they have been popular, we have identified discrete tasks and pathways that need improvement and I have enjoyed stretching my practice.