key: cord-0747312-y20v1ttv authors: Andreae, M. H.; Dudak, A.; Cherian, V.; Dhar, P.; Dalal, P. G.; Po, W.; Pilipovic, M.; Shah, B.; Hazard, W.; DLR, Rodgers; EHS, Sinz title: Healthcare simulation to prepare for the COVID-19 pandemic date: 2020-05-27 journal: J Clin Anesth DOI: 10.1016/j.jclinane.2020.109928 sha: e9fa3cd0905224b7643643408d6e08ccb9bd442e doc_id: 747312 cord_uid: y20v1ttv • COVID-19 challenged providers and organization with unfamiliar and unprecedented scenarios. • We simulated anticipated airborne contagion scenarios to familiarize providers with safe practices. • COVID-19 procedures were safely examined in realistic situations and modified based on participant debriefings. • Simulation promoted interdisciplinary integration of our organizational response to COVID-19. J o u r n a l P r e -p r o o f Letter Dear Editor, Before the rapidly expanding COVID-19 pandemic [1] reached our institution, we leveraged a training simulation to (a) test algorithms/protocols, and (b) promote organizational integration to optimize management of patients suspected of COVID-19. During previous outbreaks of contagious airborne disease, in situ simulation was successfully used to train staff, improve competency with personal protective equipment (PPE), and test protocols. Concurrent with our work, others leveraged simulation in the setting of COVID-19. [2] [3] [4] Our report is targeted at other simulation professionals, especially in anesthesia. We hypothesized that in the absence of clinical expereince, immersive simulation of anticipated scenarios can improve protocols developed in round table discussions. During initial debriefing, we applied crisis resource management concepts including situation awareness, prioritization of tasks, and clear communication to COVID-19 scenarios. In subsequent debriefing, we re-evaluated formerly familiar processes, identifying and correcting shortcomings of new protocols, kits, and interdisciplinary cooperation. Examining plans for COVID-19 management in immersive simulated scenarios revealed shortcomings before such gaps threatened patient or clinician safety. [2, 4] Crisis resource management simulation provided a safe approach to both prepare clinicians for changes in usual practice and integrate the organizational response across disciplines to confront an unprecedented pandemic. The time needed to safely orchestrate an emergency intubation for a contagious patient surprised our airway experts. Team members noted that PPE introduced additional barriers to communication and clinical activities and emphasized the need for daily and pre-engagment huddles. Teams were divided into "clean" and "dirty" members who had to adapt to specific, overtly-designated roles. Our simulations were particularly effective for practicing donning and doffing of PPE, adjusting difficult airway management and resuscitation algorithms, and adapting to likely resource constraints, echoing reports from other airborne epidemics and autors. [2, 4] Debriefings also revealed the high stress levels invoked by general uncertainty about Table Legends Table Legend The table tabulates The central theme is on team coordination, communication with hospital entities and adherence to protocol to contain viral spread. Interdisciplinary discussion to evaluate the need for transfer versus performing the procedure in patient room and coordination between "clean" and "contaminated" personnel is paramount. The central theme is communication and supervision via remote telecommunication to perform a lifesaving procedure. A focus on communication and shared mental modeling improve success in remote tele-guidance for procedures. Clinical characteristics of coronavirus disease 2019 in china The use of simulation to prepare and improve responses to infectious disease outbreaks like covid-19: Practical tips and resources from norway, denmark, and the uk Assessing operating room preparedness for covid-19 patients through in-situ simulations Use of in situ simulation to evaluate the operational readiness of a high-consequence infectious disease intensive care unit Resonant leadership: Renewing yourself and connecting