International Journal of Healthcare Simulation

Background:

Awareness of symptoms associated with frailty is uneven across acute hospital staff ^[1]. Frail patients are more likely to suffer adverse outcomes; managing frailty requires an inter-professional, multi-disciplinary approach – for which simulation has been identified as beneficial in delivering education ^[2]. Given this, in addition to multiple incidents on wards highlighting a deficiency in both technical and human factors skills, an in situ frailty simulation project was undertaken at a London teaching hospital.

Aim:

The aim of the study was to evaluate the efficacy of in situ frailty simulation in improving both technical and human factors skills for ward staff.

Method:

In situ simulation was selected to increase accessibility for staff and promote ward team learning. Sessions started in October 2020 on one ward, before moving across other wards. These 1-hour sessions have been delivered weekly with a hiatus due to the second wave of the COVID-19 pandemic. A bank of frailty-based scenarios has been created, ranging from acutely unwell patients to communication with families. Participants have been from across the multi-disciplinary team. Data were collected using pre- and post-session questionnaires – containing the Human Factors Skills for Healthcare Instrument (HuFSHI) and frailty-based knowledge questions with Likert scales. Learning has been disseminated through the department via newsletters.

Results:

Thirteen sessions have been delivered with 59 participants (23 nurses, 20 doctors, 9 physiotherapists, 6 nursing assistants, 1 occupational therapist). Forty-nine surveys were completed – 100% of participants found the sessions useful. Post-training, staff demonstrated improvement of self-efficacy in 11/12 HuFSHI questions and all frailty questions (Table 1). The most common learning themes were communication (51%), teamwork (43%) and escalation (24%), as well as management of frail patients (35%). Working with the team (47%), the scenarios (18%) and debriefing (12%) were aspects learners most liked about the sessions.

Implications for practice:

An in situ frailty simulation programme has been successfully implemented, leading to improved learner self-efficacy in both technical and human factors skills when managing frail patients. This has been well received amongst staff. In particular, the sessions have promoted interaction and teamwork within the multi-disciplinary team, which was liked by participants. The in situ delivery has allowed learning to occur without the need for staff release, widening access. Latent threats – such as missing airway equipment – have been identified during sessions and addressed. Moving forwards, funding has been secured for a departmental manikin alongside expanding our multi-disciplinary faculty.