In-situ Simulation Use for Rapid Implementation and Process Improvement of COVID-19 Airway Management

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic presents unique challenges to frontline healthcare workers In order to safely care for patients new processes, such as a plan for the airway management of a patient with COVID-19, must be implemented and disseminated in a rapid fashion The use of in-situ simulation has been used to assist in latent problem identification as part of a Plan-Do-Study-Act cycle Additionally, simulation is an effective means for training teams to perform high-risk procedures before engaging in the actual procedure This educational advance seeks to use and study in-situ simulation as a means to rapidly implement a process for airway management in patients with COVID-19 METHODS: Using an airway algorithm developed by the authors, we designed an in-situ simulation scenario to train physicians, nurses, and respiratory therapists in best practices for airway management of patients with COVID-19 Physician participants were surveyed using a five-point Likert scale with regard to their comfort level with various aspects of the airway algorithm both before and after the simulation in a retrospective fashion Additionally, we obtained feedback from all participants and used it to refine the airway algorithm RESULTS: Over a two-week period, 93 physicians participated in the simulation We received 81 responses to the survey (87%), which showed that the average level of comfort with personal protective equipment procedures increased significantly from 2 94 (95% confidence interval, 2 71-3 17) to 4 36 (4 24-4 48), a difference of 1 42 (1 20-1 63, p < 0 001) There was a significant increase in average comfort level in understanding the physician role with scores increasing from 3 51 (3 26-3 77) to 4 55 (2 71-3 17), a difference of 1 04 (0 82-1 25, p < 0 001) There was also increased comfort in performing procedural tasks such as intubation, from 3 08 (2 80-3 35) to 4 38 (4 23-4 52) after the simulation, a difference of 1 30 points (1 06-1 54, p < 0 001) Feedback from the participants also led to refinement of the airway algorithm CONCLUSION: We successfully implemented a new airway management guideline for patients with suspected COVID-19 In-situ simulation is an essential tool for both dissemination and onboarding, as well as process improvement, in the context of an epidemic or pandemic