In-Situ Simulation in the ICU

Brighton and Sussex University Hospitals NHS Trust

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Simulated scenarios created within the real world clinical environment is the holy grail of simulation. Though in-situ simulation has much to offer in terms of heightening the sense of reality that increases learner immersion, it poses challenges to daily clinical activity and is a hindrance to production participation within a pressurised work environment.

At Brighton and Sussex University Hospitals, we have spent two years exploring how to make in-situ simulation both a reality and a success with limited resources. This is our story.

Within our thirty-one bed ICU, we’ve historically had a pediatric isolation room, which has gone underutilized since the development of an adjacent children’s hospital. By partitioning the space to create a control room, and incorporating a one-way mirror, we converted the room into a dedicated simulation space, housed within the ICU.

Low resources, likewise, compelled us to be creative with our audio-visual solutions. Simple webcams and microphones, linked via laptops using Outlook software, have enabled all participants to view the simulation from a separate room.

Our simulation scenarios cover a range of clinical situations commonly encountered in critical care. We can adapt them for both medical and nursing staff of differing levels of skill and experience. Initially, we found it impossible to take staff away from the ICU floor on busy days. (We never have a quiet day!) Therefore, understanding the pressures placed upon the ICU was key to the success of the programme. With support from senior managers, we rotated staff to a simulation day. We currently run the simulation day once a month, with a faculty that includes medical and nursing colleagues. We place a strong emphasis on teamwork training to develop a robust debrief with good judgment within a flattened hierarchy.

Embedding simulation within our ICU training has proved to be so successful that we’ve extended its use beyond individuals to the wider department. Our induction processes, checklists, and guidelines have all been adapted based on the learning we’ve achieved from simulation. These developments have allowed us to create a conducive environment for all of us to learn and grow together.

Dr. Kate Regan
Consultant in Critical Care and Anaesthesia
Brighton and Sussex University Hospitals NHS Trust