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COVID-19 resulted in major challenges to our global health systems. We had to develop clinical protocols to care for COVID-19 patients with a very short window for design and deployment. We hypothesized that in situ simulation-based clinical system test (SbCST) could help identify latent safety threats (LSTs) in the newly developed protocols for COVID-19 patients in the operating room. The primary outcome was the number of LSTs identified. The secondary outcome was the perceptions of staff related to the process collected via post-training survey data.


This observation study took place in the CMH OR and was approved by the IRB. Prior to arriving participants were instructed to review the COVID protocol and watch the training video that had been developed. Each participant began as the assistant and then participated as the airway manager for the next scenario. Short debriefs reviewed guidelines, and gathered staff input, and then staff repeated the simulation to consolidate learning. After completion each participant completed a brief survey to evaluate for knowledge gained, feasibility, acceptability, and suggestions for improvement. Members of the department then completed a follow up survey 4 months later.


A total of 14 anesthesia staff completed the training. A total of 17 unique LSTs were identified. A resolution was found for all LSTs. (Table 1)

In all, 12 participants filled out the post debriefing survey. All strongly agreed it was worth their time. 92% strongly agreed and 8% somewhat agreed that this was an acceptable way to improve system readiness and staff knowledge and that this was an effective way to test changes and provide feedback. All participants strongly agreed that the debriefing process allowed them to share their ideas for improvement.


We found that in situ simulation is a good way to prepare for disease outbreaks and test the development of new protocols. It allowed for the practice of care team dynamics within the actual clinical environment. It also enabled us to identify and address unexpected problems that were not obvious during the formulation of the protocols. Based on the staff perceptions this method was highly rated and worth the time it took.


In situ simulation of our COVID-19 protocols allowed us to identify and address problems not foreseen during the planning stages and led to many downstream changes to the protocol. It improved participant compliance and increased their confidence with the new process.

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A Novel Approach To Operating Room Readiness For Airborne Precautions Using Simulation-Based Clinical Systems Testing



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