G24(P) Out with the old, sim in the new

Aims To develop paediatric asthma and diabetic ketoacidosis guidelines based on acknowledging human factors through simulation whilst developing clinician understanding of the conditions. Methods Most NHS district general hospital emergency departments are busier than ever. Fewer foundation trainees undertake specialty training such as paediatrics and it is these FY2 and FY3 doctors who provide the backbone of ED staffing. Asked to amend the existing paediatric asthma and diabetic ketoacidosis pathways for these staff we consulted allied healthcare professionals, used local tertiary practice and national guidance to develop new acute care pathways. We designed these new pathways for use by junior non-expert clinical staff in a busy district general paediatric emergency department to reduce medication error, give the best evidence based care to patients, reduce unnecessary admissions and give confidence to junior medical staff. The pathways were then refined through a series of simulation sessions working through previous pathways and then the new ones. Results 42 healthcare professionals and students were involved in simming the new pathways with written feedback from 28. Each arm of each pathway was tested with feedback being received verbally in situ and written at the end. Each simulation session involved a clinical and non-clinical human factors debrief from a consultant and trust sim lead. The sessions resulted in clinician confidence in their management of paediatric asthma and DKA increasing from a mean of 2.9/5 to 3.7/5. Pathway ease of use went from 2.3/5 to 4.7/5 and accordingly, clinicians felt that patient safety was improved from 2.3/5 to 4.1/5 with the new pathways. Multiple amendments were made to the new pathways including ordering of words, colours, fonts, timings and bulletpoints. Serial numbers command more attention than bulletpoints. Timings are seen as too proscriptive. All clinicians stated that simulation is an effective way of introducing and refining policies and pathways. Conclusion Simulation is an essential method of introducing and refining care pathways in order to reduce simple common errors made in interpreting them. New care pathways should be run through simulation by the professionals who are going to use them.