A late-night stop at a convenience store turns into a life-or-death situation for a father and his adult daughter who become unwitting victims in a violent robbery. Their lives are on the line when they arrive at the VGH Emergency Department’s trauma bay with multiple stab wounds and limited information.

This was the scenario as VGH teams came together last month for a unique and complex simulation event designed to gain insight into systems issues, team dynamics and crisis resource management during patient care. This was the largest simulation event ever held within VCH and involved the laboratory medicine, anesthesia, emergency medicine, trauma services, PACU and OR teams at VGH. The simulation started in the Emergency Department in the morning and moved on to the OR in the afternoon.

“By having multiple departments and multiple roles, this complex simulation provides a unique opportunity to evaluate our current systems and learn from one another,” said Dr. Nicolle Holm, VGH emergency physician and one of several physician leaders who organized the event. “This is about communication, processes and systems resiliency. No individual is tested or assessed. Mistakes will help us learn and improve.”

Simulation a tool for engagement and quality improvement

This was the fourth and largest simulation event at VGH, with more than 100 participants actively involved across multiple departments. Previous, smaller events involved volunteers participating on their own time.

There’s increased awareness of the value of simulation as a tool for engagement and quality improvement. This most recent event took six months to prepare, with more people stepping forward to participate. Thanks to support from the Vancouver Physician Staff Association (VPSA) Facility Engagement Initiative, the VGH & UBC Hospital Foundation and VCH administration, this most recent simulation event funded staff and physicians to participate, and provided breakfast and lunch to keep them going throughout the day.

“The support from VCH leadership, the Foundation and the VPSA Facility Engagement Initiative has made it possible to expand the event and enhance the opportunity for learning,” said Dr. Andrew Sawka, Vancouver Acute medical director of perioperative services and physician lead for the mega simulation event. “Everyone who participated was here because they wanted to learn and contribute to system improvement.”

Sharing experiences supports system-wide enhancements

Debriefs following the morning and afternoon scenarios provided valuable feedback and resulted in a number of action items and working groups. Participants shared their perspectives from the simulation experience in a safe and open environment. Comments included:

• “This is the most highly intensive simulation that Lab has ever been involved with. It felt a little chaotic but people figured things out.”
• “I felt the teamwork and rush of adrenaline like when we don’t know when the patient is going to come through the door.”
• “The more chaotic the situation, the less time there was for communication. Our systems need to be foolproof.”
• “I realized a shocking amount of work happens behind the scenes.”