Keeps The Heart Beating

Cardiac arrests are (thankfully) not routine or everyday events. But cardiac surgical patients are unique because their cardiac arrests are often due to surgery-related complications, unlike other patients who develop cardiac arrest as a result of medical reasons such as acute myocardial infarction. Hence, the initial response for this special group of patients has to be quite different from other approaches to the management of cardiac arrest. 

Read as Dr Chong Shin Yuet, Course Director of Singapore's first Cardiac Advanced Life Support (CALS) Surgical Course, shares how this simulation course will enhance teamwork in the Cardiac Intensive Care Unit (CICU) and on her passion for healthcare simulation.

1. The inaugural CALS surgical course, which originated in the United Kingdom, was held for the first time in Asia at Academia in partnership with the SingHealth Duke-NUS Institute of Medical Simulation (SIMS). Tell us more about this course and how will it potentially improve the way our healthcare teams work in the CICU.

When I was first told about the CALS Surgical Course, I was very excited to know that such an established training course in Cardiac Arrest Resuscitation exists. This course focuses on training the CICU interprofessional healthcare team in the resuscitation of cardiac surgical patients after cardiac surgery. What I like about it is that it trains participants in areas beyond procedures and technical skills. It also places emphasis on teamwork and other crisis resource management principles, which is what simulation-based education is best for.

The use of well-validated protocols in the CALS course, much like those used in the ACLS (Advanced Cardiac Life Support) and ATLS (Advanced Trauma Life Support) courses, coupled with realistic simulation methods will empower the on-call teams to manage their patients confidently and competently. This will have a significant positive impact on patient resuscitation outcomes.

2. What do you think contributed to the success of this course?

We had five overseas Faculty who flew in to run CALS in Singapore. They were very impressed with the top-notch simulation facilities that we have at Academia and commented that our healthcare simulation facilities were the best they had seen in comparison to simulation centres in other countries such as the United States, Australia, and New Zealand! The Faculty and participants also commented the course was really well-run with great support and expertise from the SIMS team.

3. In your opinion, how has healthcare simulation training benefited you and your department?

Oh, I could go on and on! Personally, simulation training has definitely improved my crisis resource management skills. I find myself maintaining a cooler head because I have run these crisis scenarios numerous times before. In fact, we had a case of anaphylactic shock recently and simulation training helped me to avoid fixation errors and improved my communication skills. These were instrumental in the success of our resuscitation efforts, and I was so relieved when the patient was discharged well!

In my department, we aim to reproduce such conditions through our monthly in situ Operating Theatre and ICU simulation workshops. We train our own Anaesthesia doctors with other surgeons and nurses as a multidisciplinary, interprofessional perioperative team. We have found that the frank conversations among the simulation workshop participants during post-scenario debriefs have helped to broke down communication barriers. 

These in situ sessions have also made the various professions more aware and appreciative of the diverse roles we each play in a healthcare team. For example, the scrub nurses mentioned that they now pay more attention to the location of essential resuscitation equipment and drugs. This is so that they can help the Anaesthetic Unit (AU) nurse retrieve these in an anaesthetic emergency since the AU nurse often works alone and juggles many competing tasks during a crisis.

From left to right: Lu Ruli and Kok Pei Lai, Nurse Clinicians, SGH; Dr Wong Loong Tat, Senior Consultant, Department of Anaesthesiology, SGH; Dr Chong Shin Yuet, Director of Simulation, SingHealth Anaesthesiology and Perioperative Services ACP; Sabrina Koh, Co-Director of SIMS and Deputy Director, Nursing, SKH; and Sng Bixia and Chong Jaan Hwan, Simulation Technologists, SIMS.

4. What are you most excited about in healthcare simulation training and why?

I am most excited about translational simulation – using simulation to improve healthcare delivery processes and solving problems within our healthcare system. We have long been identifying latent threats in our healthcare environment and delivery processes via our in situ simulation programmes at SIMS and with the Anaesthesiology Division's Clinical Services and Quality Committee to remove or mitigate these latent threats. 

Moving forward, I hope to use healthcare simulation not just for the diagnosis of safety and performance issues, but also to expand its role in the area of interventions i.e. to target practice behaviour or patient outcomes.

5. What advice would you give to educators who are keen to incorporate healthcare simulation into their training?

First, find a few like-minded individuals who share your passion for healthcare simulation education. It will be helpful to have a team of Faculty for mutual support and for bouncing ideas off one another. 

Next, start with the problem you want to solve, then decide on the learning outcomes when you design your simulation-based education course. Keep things simple – don't try to achieve too many learning objectives in one sitting.

Third, invest time and effort to improve your debriefing skills. The debriefing process is where most of the learning takes place.

Lastly, don't feel shy to approach SIMS for advice. If you face any challenges in planning for simulation programmes, they have a very experienced and helpful team of healthcare simulation experts and technicians who will guide you along!        

6. As the Co-organising Chairperson of next year's S3 Conference, share with us briefly what can our delegates look forward to.

The inaugural S3 Conference in 2017 was a huge success! For the Conference in 2019, we hope to create a platform for the exchange of valuable experiences and innovative ideas in simulation-based education. Indeed, we hope that even more simulation educators from all over the world will join us next year.

There are cultural differences as to how simulation education is done in different parts of the world. I look forward to bringing together a diverse mix of speakers and delegates, so that we can gain new insights and holistic perspectives on all aspects of simulation. Do keep a lookout for news on the S3 Conference 2019 coming your way soon!