Abstracts

Rationale: Patient safety has emerged as a critical topic for directors of EMUs. Assessment and management of changes in patient condition in the EMU is a complex process involving multiple providers with varying levels of training and experience. Successful management requires effective communications, hand offs, and the institution of a variety of therapeutic strategies. These factors increase delay in treatment and errors in care, potentially leading to adverse events. Although such events are uncommon, they have been reported in the EMU. To address these complexities and support effective team performance, we developed a simulation-based team training program for nurses and physicians to maximize their ability for safe care in the EMU. Medical simulation is an effective method of training medical teams, improving assessment, decision-making, and the institution of treatment strategies in unanticipated patient events. Using simulated scenarios based on actual EMU sentinel events, we aimed to introduce and educate neurology residents and nurses to the essential procedural and decision making steps required for EMU care. Methods: We used a mixed methods study design for two distinct phases of this research project: expert review and consensus in appropriate patient management, and creation and implementation of a simulation based curriculum for multidisciplinary teams. The initial needs assessment/ gap analysis used prior EMU sentinel events as well as the results of hospital root cause analyses (RCAs). A local panel of experts, including two nurses, and three neurologists all with >5 years experience in the EMU and one emergency physician, reviewed the videos of sentinel events and RCAs to identify critical procedural and decision making steps necessary for maximizing care. Through an iterative process to obtain expert consensus, a 14 item procedural checklist was developed to deconstruct and assess appropriate patient care performance. Once the checklist was developed and validated through expert review, the simulation curriculum was initiated. Consent to videotape and review simulations was obtained from participants and the study was approved by the IRB. After receiving an introduction emphasizing teamwork, leadership, communication, and evaluation of change in patient condition in the EMU, subjects were introduced to the medical simulator. Employing the procedural checklist and through interactive video-debriefing, trained facilitators identified strengths and weaknesses of individual and team performance and emphasized essential objectives. Results: A simulation-based team training curriculum and procedural checklist was created and validated for patient safety in the EMU using review of sentinel events and RCAs. Conclusions: A practical simulated curriculum is feasible and valid to train seizure safety in the EMU and may have broader applications for safety training. Reliability of the procedural checklist is planned by measuring kappa coefficients for inter-rater agreement of the assessed simulations.