The Use of Simulation in Health-Care Response to COVID-19

Sara S Aldekhyl; David J Elbling; Yassen M Arabi

doi:10.4103/sccj.sccj_43_20

BRIEF REVIEW

Year : 2020 | Volume : 4 | Issue : 5 | Page : 28-30

The Use of Simulation in Health-Care Response to COVID-19

Sara S Aldekhyl¹, David J Elbling², Yassen M Arabi³
¹ Department of Intensive Care, Skills and Simulation Center, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
² Department of Intensive Care, McGill University Health Centre, Montreal, Canada
³ Department of Intensive Care, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia

Date of Submission	02-Sep-2020
Date of Acceptance	28-Sep-2020
Date of Web Publication	7-Dec-2020

Correspondence Address:
Sara S Aldekhyl
Department of Intensive Care, King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Khasmal-an, P.O. Box 22490, Riyadh
Kingdom of Saudi Arabia

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/sccj.sccj_43_20

Abstract

In preparation for the COVID-19 pandemic, simulation came in handy in aiding health-care facilities around the world to establish strategies to manage its personnel, space, and processes through experiential learning. Simulation bloomed during the epidemic due to its flexibility and capacity to train large number of health-care professionals at different levels in a timely manner while maintaining high safety profile. This brief review aims at providing some examples of simulation use in the era of COVID-19 pandemic around the world. In addition, we will address some of the limitations that faced simulation-based learning and provide a glimpse to the future of simulation in addressing global pandemics.

Keywords: COVID-19, critical care, health care, medical education, pandemic, pandemic preparedness, simulation

How to cite this article:
Aldekhyl SS, Elbling DJ, Arabi YM. The Use of Simulation in Health-Care Response to COVID-19. Saudi Crit Care J 2020;4, Suppl S1:28-30

How to cite this URL:
Aldekhyl SS, Elbling DJ, Arabi YM. The Use of Simulation in Health-Care Response to COVID-19. Saudi Crit Care J [serial online] 2020 [cited 2023 Feb 8];4, Suppl S1:28-30. Available from: https://www.sccj-sa.org/text.asp?2020/4/5/28/302581

Introduction

Simulation has demonstrated great potential in advancing health-care systems at various levels during the COVID-19 pandemic. It effectively facilitated the training of large number of health-care professionals at different levels in a timely manner either individually or in multidisciplinary teams through experiential learning.^[1],[2],[3] In addition, simulation use has been associated with improved team morale and buy-in to adopt new or modified practice compared to traditional distribution of guidelines.^[4],[5] From an educational theory prospective, the capacity of simulation to reduce cognitive load aided in optimizing the educational outcomes during this stressful period compared to classical bedside training/in-service presentations, by removing the risk of contracting the infection from patients and alleviating concerns of precipitating adverse outcomes during training.^[6] At an operational level, well-equipped simulation centers were utilized as an overflow area for patient care as part of surge capacity management. Other centers mobilized their equipment and supplies to support acute care areas.^[7]

Examples of the Use of Simulation in COVID-19 Response

In preparation for the COVID-19 pandemic, simulation came in handy in aiding health-care facilities around the world to establish strategies to manage its personnel, space, and processes to provide a safe environment for its workers and high-quality care for patients. In this section, we will provide some examples of simulation use in the era of COVID-19 pandemic.

Locally, the Saudi Council for Health Specialties delivered multiple courses aimed at upscaling health-care professionals around the country in preparation for the pandemic. These courses were designed at multiple levels of complexity and tailored to target trainees from different levels and backgrounds.^[8],[9] More details on these projects can be found in a dedicated review article in this special edition of the Critical Care Journal. King Abdulaziz City for Science and Technology developed a COVID-19 propagation simulation model that aims to simulate the dynamism of the disease behavior to provide an informed decision and policy-making process.^[10]

At an international level, the World Health Organization developed multiple simulation-based exercises to aid the COVID-19 preparation efforts of different countries. The aim of these templates is to target as many areas of the pandemic as most countries have to deal with. Modules include areas such as (a) examining and enhancing the plans, procedures, and capacity to manage an imported COVID-19 case, (b) infection prevention and control measures, (c) point of entry exercise packages to review issues at the main airport, and (d) discussing critical issues in urban environments during the rapid spread of the disease.^[11] On disease spread, intervention, and outcome prediction, numerous open and closed source simulation remodeling systems are currently available with variable complexity and functions.^[12],[13]

Critical care in particular is an area that has used simulation in COVID-19 response. [Table 1] highlights some of the roles of simulation at different domains in health care.

Table 1: Examples of the use of simulations in critical care settings during COVID-19 pandemic

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Limitations of Simulation Use during COVID-19 Pandemic

The widespread utilization of simulation-based activities was limited due to multiple factors. First, infection control and social distancing measures significantly lowered the maximum number of participants that could be accommodated at each simulation-based training session. The repurposing of simulation centers (converted to COVID-19 patient screening or care extension areas) and closure of centers added extra constraints to the availability of physical space for simulation use. Financial and manpower limitations are other factors that have further affected simulation utilization widely. Despite abiding with all infection control measures, attendance was suboptimal due to participants’ fear of contracting the infection during the sessions. The shortage of available personal protective equipment in nonpatient care areas did not help alleviate those fears nor did it help with the possibility of safely increasing the number of participants.

Second, the busy schedule of both the trainers and trainees limited the number of sessions scheduled, however this appears to have been compounded by the exhaustion and possible burnout of all staff, thereby limiting attendance further.

Finally, budget constraints and the limited availability of simulation technologists and support staff further exacerbated the aforementioned hindrances.

Future

Simulation has shown its utility during this pandemic. In addition to being an educational tool, optimizing the individual, team, and process in the system, it can be utilized innovatively to support the work in the health-care facilities.^[7]

Simulation has the potential to prepare the health-care system and the entire country to evaluate what has been done and provide insight to what can be expected. Pandemic data and different measures can be plugged into epidemiological remodeling simulators that assessment decision makers in making more informed decisions. Following needs assessment, simulation-based interventions can be designed to bridge the perceived gaps of the first wave to better prepare for a potential second wave. In addition, retraining and upscaling the skills of the health-care providers in anticipation for a surge in the needs.

Ingrassia et al. proposed a model for safe reopening of simulation centers based on national and international guidelines and flexibility. Reopening the simulation centers has to occur in a thoughtful and innovative approach as reopening does not mean “back to normal.”^[26]

COVID-19 pandemic has brought simulation further into the spotlight. As more experience has been accumulated and more participants have participated in simulation-based activities, the black box and confusion have cleared around this modality.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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