Abstract
Introduction
Geriatric medicine is inherently complex and requires multidisciplinary integration. Simulation-based training is recognised as a method to enhance learning and improve patient outcomes.
This project aimed to develop a multi-professional simulation programme within care of the elderly to mimic the multi-professional practice of geriatrics.
Methods
Ten half-day simulation sessions were run across two sites over two years. The scenarios cover frailty, orthogeriatrics, acute delirium, Parkinson’s disease, thrombolysis and palliative care.
There were 57 participants, including 24 doctors, 20 nurses, 7 nursing students, 4 healthcare assistants and 2 physician associates.
Quantitative and qualitative questionnaires conducted pre- and post- simulation were used to assess confidence levels and attitudes towards simulation.
Results
Both pre- and post- simulation, candidates had the most confidence in managing end-of-life situations, and least confidence in managing patients with Parkinson’s disease.
Confidence levels for managing common geriatric scenarios increased by an average of 21% after candidates participated in the session.
Thematic analysis highlighted the importance of collaboration within a team and pro-activeness of staff to highlight deteriorating patients to colleagues and family members.
Conclusions
Simulation that mimics the ward environment is an effective tool in increasing the confidence of the MDT looking after geriatric patients through exposing candidates to complex situations and increasing awareness of roles within the team.
The simulation sessions have highlighted common clinical areas that require further education within the Trust, such as thrombolysis. Future development of the simulation will aim to adapt the scenarios for the use of the wider MDT.
Comments
Simulation sessions
Thanks for submitting this work, great to see simulation sessions being delivered around care of older people. Could you provide further information on the scenarios that you created? Was the improvement in confidence similar for all healthcare professional groups?
Thank you for your questions. We initially had 4 scenarios which were:
- an acutely deteriorating orthogeriatric patient who was 2 days post op
- a new admission to A&E presenting from a nursing home with delirium and HHS (also had issues re safeguarding)
- an acutely unwell patient with Parkinson's disease who was a couple of days into admission and had missed key medications
- a new admission acutely deteriorating and approaching end of life- scenario was focused around discussion with family.
We later introduced a thrombolysis scenario for a stroke admission patient.
All the scenarios were designed so nursing staff would assess first and then call for doctors support as they would normally in the ward setting. Some of the scenarios were also ameanable to make more challenging depending on the candidates.
The improvement in confidence was seen across all the HCP groups with similar values, and across all groups the greatest improvement in confidence was for management of Parkinson's disease patients.
I hope that answers your questions!