Simulation-based interprofessional conference: a focus on patient handoffs and critical communication

Introduction

The WHO expert group in Geneva has discussed the concept of interprofessional education as early as 1973. Several decades later the WHO published the Framework for Action and Interprofessional Education and Collaborative Practice in 2010.¹ The key messages of the framework are that interprofessional training is necessary to have a collaborative practice-ready workforce, and that this training strengthens health systems and improves health outcomes. A key component of interprofessional training is communication education around patient handoffs. A handoff is the process of transferring patients and their healthcare information from one team of caregivers to another. There is clearly a causal relationship between effective handoffs and patient outcomes, such as adverse events.^{2 3} To that end, acutely ill patients rapidly transition through the healthcare system and are cared for by multiple teams of providers in a very short time period. The ability of these teams to effectively deliver interprofessional care and safely perform patient handoffs is paramount for good outcomes.

Why an acute care conference

We sought to develop an interprofessional conference where providers could follow a patient from first contact with healthcare professionals in the prehospital setting to definitive specialty care. This format would allow every provider insight into challenges faced by other teams as they cared for the patient. Additionally, each professional could see the upstream and downstream effects of their actions and communication and how this impacts the care provided to the patient. To that end, we specifically addressed how high-quality patient handoffs occur from one team to another. This conference provided the unique opportunity for interprofessional teams to actually practise this skill, as opposed to learning about handoffs within their professional silos.

How the conference was executed

The conference was attended by paramedics, emergency medicine and critical care nurses, respiratory therapists, pharmacists, emergency medicine residents, advanced practice providers, and attending physicians from emergency medicine, cardiology, trauma and neurology. It was structured with didactic presentations for 90 min in the morning, followed by an interactive 1-hour audience response session. The remainder of the day consisted of three separate immersive simulations covering ST elevation myocardial infarction (STEMI), stroke and trauma patient scenarios (table 1). The simulation cases were written by content experts in conjunction with the authors and were not based on actual patients.

Table 1.

Schedule of events for acute care simulation conference

Time	Activity
08:00–08:15	Registration and continental breakfast
08:15–08:30	Welcome
08:30–09:30	Keynote ‘Crew Resource Management’
09:30–09:45	Break
09:45–10:45	Interactive audience response scenarios
10:45–11:00	Orientation and safety briefing
11:00–12:45	Immersive cardiac simulation
	Case: 62-year-old male develops chest pain and diaphoresis
	Paramedics: Obtained EKG (STEMI), obtained intravenous access, administered aspirin
	Emergency department: patient developed ventricular tachycardia, CPR performed, patient intubated and had return of spontaneous circulation
	Catheterisation lab: additional antiplatelet agent given, heart catheterisation performed, stent placed
12:45–13:45	Lunch
13:45–15:30	Immersive neurological simulation
	Case: 65-year-old male with sudden-onset slurred speech and left-sided weakness 10 min ago
	Paramedics: performed evaluation for stroke, notified hospital of potential stroke victim
	Emergency department: performed NIH stroke scale, performed head CT, started thrombolytics, patient decompensated requiring intubation
	Interventional radiology: patient taken for emergent thrombectomy
15:30–15:45	Break
15:45–17:30	Immersive trauma simulation
	Case: rollover MVC; victim 1—ejected with abdominal and pelvic injuries; victim 2—partially ejected with leg pinned under car
	Paramedics: victim 1—established intravenous, administered fluid, applied pelvic binder; victim 2—established intravenous, administered fluids, applied tourniquet
	Emergency department: victim 1—trauma survey, administered fluid and blood, fluid seen on abdominal ultrasound, remained hypotensive; victim 2—trauma survey, administered fluid and blood, vitals responded to blood
	Operating room: victim 1—taken for emergent laparotomy and splenectomy; victim 2—taken for amputation by orthopaedics
17:30–19:00	Conclusion and reception

STEMI, ST elevation myocardial Infarction; EKG, electrocardiogram; CPR, cardiopulmonary resuscitation; NIH, National Institute of Health; MVC, motor vehicle collision.

Each simulation was allotted 105 min to execute and debrief. Volunteers from the audience were asked to provide care to the victim while functioning in their usual role on the team. Each scenario started in the prehospital setting. Paramedics from the audience provided care to the victim and transported them to the emergency department. There the patient was assessed and treated by the emergency department team that again consisted of members of the audience. Finally, the patient was transitioned to the appropriate specialty service. The patient with STEMI was taken for cardiac catheterisation; the patient with stroke was taken for thrombectomy by interventional radiology; and the patient with trauma was taken for damage control laparotomy in the operating room. For those learners who were not participating in a given scenario, the entire simulation was streamed live into the auditorium from the prehospital setting to the emergency department to definitive specialty care, clearly demonstrating all aspects of care including patient handoffs.

After each scenario the participants were brought back to the auditorium and a structured debriefing took place. An expert debriefer, and member of the emergency medicine faculty, facilitated the debriefing. Attending physicians from the respective specialties provided content expertise. The audience was able to actively participate in the debriefing and discussion.

Conference evaluation

Overall, the conference was very well received by the learners, with nearly all of the participants rating the session as ‘Good’ or ‘Very Good’. During the debriefings several participants noted that their practice would improve as they were able to more clearly see how the patient’s historical information they obtained and handed off could directly impact and improve the care provided to the patient. Additionally, several professionals discussed that they could now appreciate the difficulties faced by the other specialties who are also providing care to their patients (ie, emergency department personnel recognising the austere environment the paramedics were working in, or the specialty services understanding why the emergency department may be acting on limited information). Throughout the day the faculty noted graduated performance improvement, especially in the areas of focus including closed loop communication, role designation and communication during handoffs. This change of behaviour demonstrates knowledge transfer and behaviour change consistent with the Kirkpatrick level 3 of training evaluation, typically difficult to demonstrate in many professional development courses secondary to the lack of interactivity.⁴

Lessons learnt

We note that executing a conference like this was labour-intensive and required a highly specialised centre. However, this course demonstrated that healthcare providers who commonly interact with one another, yet rarely train together, can learn and apply effective strategies for interprofessional teamwork and patient handoffs, and in so doing can potentially have a positive effect on patient care.