Rapid upskilling through simulation to provide a safe COVID-19 inpatient mobile emergency rapid intubating team

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Rapid upskilling through simulation to provide a safe COVID-19 inpatient mobile emergency rapid intubating teamThe development of COVID-19 in-hospital mobile emergency rapid intubating teams (MERIT) was recommended to manage critically ill patients with COVID-19-associated respiratory failure. 1 In our centre, availability from the cancellation of routine operating meant that the MERIT role was devolved to the anaesthetic workforce; developing the role raised unique and specific challenges for clinicians not usually caring for acutely unwell ward patients requiring admission to the intensive care unit (ICU) including daily variation in team members, multiple teams deployed simultaneously, lack of familiarity intubating outside of the operating theatre environment and the inherent difficulties performing the intervention in personal protective equipment (PPE).Rapid upskilling to staff this MERIT service required significant culture shift.Educational reframing permitted adaption to a standard operating procedure (SOP)-driven model benefiting from commonality of language, decreased cognitive load and with a subsequent expectation of improvement in safety.2,3 The full MERIT service was delivered two days after simulation commenced, so training and implementation were concurrent by necessity.Training was delivered by a multidisciplinary team using high fidelity simulation of the full MERIT pathway, preceded by dissemination of a video recording of faculty members completing the simulation.The pathway was enacted in full to improve validity, including team briefing, use of a replica MERIT equipment trolley and ventilator, simulation of drawing up drugs, starting infusions, donning and doffing PPE, and intubation and subsequent moving of the patient to ICU.Following initial training, additional focused MERIT simulation was repeated daily with the aim of improving team synergy, effective working and interpersonal communication, in addition to allowing protocol recapitulation and team specific post simulation debriefing.4,5

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