Simulation training at the point of care to decrease the incidence of airway complications on the intensive care unit

Introduction

A recent analysis of critical incidents reported to the National Patient Safety Agency (NPSA) by ICUs in the UK revealed a significant number of airway incidents in critical care [1]. We recently performed an online survey with responses from 305 trainees from across the UK regarding airway management and complications on the ICU. The results revealed a high number of adverse airway events including 27 deaths. A large number of junior trainees (many of whom cover the ICU alone at night) expressed low confidence levels with airway management in critical care, and the majority of all trainees felt inexperienced with tracheostomy care and emergencies. Simulation has been recommended as a suitable way of providing critical incident training [2], and simulation at the point of care has been shown to be especially powerful and effective [3].

Methods

In response to our survey, we set up a multidisciplinary simulation-based airway teaching programme for all staff on our unit. A Resusci-Annie™ manikin with an Airway Trainer™ head (Laerdel, Norway) is set up in a bed space on our ICU. Realistic patient monitoring is achieved with the Laerdel SimMan™ software (free from the Laerdel website). We have written a number of scenarios in response to incidents and training deficiencies highlighted by our survey. Scenarios are run with ICU staff from all disciplines acting within their normal roles. Realism is enhanced by staff practicing in their usual working environment, using the unit's own equipment.

Results

So far, we have trained 43 ICU staff. Feedback has been excellent, with scores ranging from 8.5 to 10. Participants were especially positive about the multidisciplinary aspect of the training and on practising uncommonly encountered scenarios in their normal workplace.

Conclusions

We have created a multidisciplinary airway training programme to practice critical incident drills at the point of care. This teaching method is low cost, simple and can be set up quickly and spontaneously during quiet periods on the ICU.