Utilizing In-situ Simulation to Improve Knowledge and Confidence in the Care of Trauma Patients

Trauma 1 patients have life or limb time-sensitive injuries that require urgent and critical management. Caring for these patients creates an environment that is stressful and error- prone, and these patients require a specific skill base that is utilized less often in the Emergency Department. In 2022, in an urban Trauma 2 Hospital, Trauma 1 patients accounted for only 0.22- 0.66% of total patients. Simulations are an efficacious and cost-effective way to improve patient outcomes and improve the confidence of healthcare personnel. This quality improvement project implemented in-situ simulations focusing on caring for Trauma-1 patients. Methods: Discussion groups were held with key trauma leaders to create objectives and goals for the simulations. Ten different sessions were held, with two simulations each, with 105 nurses and technicians completing the sessions. The project lead independently made pre- and post- simulation surveys to assess changes in confidence in emergency nurses' and technicians' different skills and decision-making capabilities while in a trauma. The Non-Technical Skills- Based Trauma Simulation (T-NOTECHS) survey was also included in the post-survey. Usability, satisfaction, and feasibility survey questions were included as well. Additionally, a follow-up discussion group was held with key leaders a few months after the simulations had been completed. Results: The project included 105 nurses and technicians who completed the simulations, with 70% (n=69) fully completing the pre- and post-survey. A statistically significant improvement (P < 0.001) was found in confidence and knowledge of skills and processes, including art lines, chest tubes, and massive transfusion protocol. In addition, there was a statistically significant improvement (p <0.001) in confidence in caring for trauma 1 patients and situation awareness. The majority of staff who completed the post-survey stated they would like to do similar trauma simulations in the future (97.1%, n=66). In addition, The majority (98.6%, n=67) of staff state that it is feasible to do simulations similar in the future. Conclusions: Simulations improved confidence and knowledge in caring for trauma patients. The ED leadership endorses the annual implementation of trauma simulations. Simulations could be expanded and improved both within the ED where the project was implemented and in departments of a similar size. Research has shown that simulations have multiple benefits, including improving patient outcomes, reducing costs, and improving confidence in caring for patients. It should be used in a variety of healthcare settings.