Can in-situ simulation be used to improve care of the acutely ill patient by enhancing interprofessional working within the primary care setting?

Problem

Acutely unwell patients in general practice are uncommon, but when they occur it requires intervention from the entire staff (clinical and non-clinical) working as a cohesive team. Despite the advantages of interprofessional education being well documented, there is little research evidence of this in the primary care setting. Primary care education has the tendency to be profession-specific with a siloed approach. Moreover, the inclusion of non-clinical colleagues (despite their close working relationship) seems even sparser. This project aims to improve care of the acutely ill patient by enhancing interprofessional working, using in-situ simulation.

Approach

The first stage of this mixed methods evaluation study is to scope current education provision within GP practices in Health Education England Kent, Surrey and Sussex (HEEKSS) and the type of methods used, with specific questions regarding the use of simulation technology. A survey will be sent to all practice managers of the 600+ GP practices within HEEKSS with a follow-up email or phone call if not returned.In the second stage (March 2018 onwards) a simulation of cardiac arrest will run in three practices within HEEKSS. Cardiac arrest has been selected due to its severity and the time-critical response required. The simulation will run for approximately 20 minutes and be filmed. It will include both clinical and non-clinical staff, all of whom will be involved in a group debrief session immediately afterwards. This will be followed by individual semi-structured qualitative interviews, either face-to-face on the same day or within the next fortnight by telephone.

Findings

The quantitative and qualitative findings from stages 1 and 2 of the research will be used to develop and evaluate a simulation scenario that can run within a GP practice and allow the multiple clinical and non-clinical staff members to work together in order to successfully respond to, and manage, acutely unwell patients.

Consequences

Whilst there is a plethora of research showing the value of high fidelity simulation within medical training in general, there is very little focusing on primary care and specifically the training of multidisciplinary teams within this area. The development of a simulation scenario for practice staff, occurring within the GP surgery itself, has the potential to improve the response of staff to, and management of, acutely unwell patients.