The Yale Center for Medical Simulation (YCMS) was recently awarded a $1 Million RO1 grant over two years from the Agency for Healthcare Research and Quality (AHRQ) for their study, “Improving patient and clinician safety during COVID-19 through a rapidly adaptive simulation intervention.” In response to the urgent need for innovative strategies that address the COVID-19 public health crisis, YCMS faculty developed a project that will implement the COVID-19 Responsive Intervention: Systems Improvement Simulations (CRI:SIS).
The effort aims to use simulation-based training and quality improvement intervention to minimize physician stress and improve system responsiveness, according to Leigh Evans, MD, Executive Director of YCMS and principal investigator. “Our frontline workers are facing a national crisis and unprecedented stress on their personal safety and wellness. Medical simulation provides the ideal opportunity for standardized practice for high-stakes events and identification of latent safety threats during COVID-19 care to combat that stress,” said Evans. “We will develop a packaged set of immersive simulations that can be rapidly deployed based on qualitative data from staff participants and guidance from the departmental COVID-19 Emergency Department Task Force.”
The proposal aims to identify factors that influence system responsiveness, hazards, clinician stress and burnout, and adoption of COVID-19 care delivery protocols through qualitative interviews with clinicians and structured field observations during the care of critically ill COVID-19 patients. They will assess the efficacy of a simulation intervention on physician stress and anxiety during the COVID-19 pandemic through a multi-site, randomized clinical trial assessing changes in heart rate variability as a physiologic measure of stress and State-Trait Anxiety Inventory as a measure of physician anxiety.
Additionally, they will test a simulation-based process improvement strategy that informs iterative refinement of COVID-19 care guideline updates and supports physician engagement in safety culture via focus group debriefings with emergency physicians and measurement of changes to the AHRQ Hospital Survey on Patient Safety Culture. The research team will plan to disseminate CRI:SIS through webinars and hands-on coaching with sister institutions facing the national COVID-19 surge to improve and evaluate the responsiveness of healthcare delivery systems and healthcare professionals during the pandemic. This grant is supported by co-investigators Jessica Ray, PhD; Ambrose Wong, MD, MSEd; Melissa Joseph, MD; James Bonz, MD, Arjun Venkatesh, MD, MBA, MHS; and James Dziura, PhD. One of the largest medical school simulation centers in the country, serving as a model for other institutions, YCMS is a 4,950 square foot, Society for Simulation in Healthcare accredited, state-of-the-art center, promoting the acquisition of basic and advanced clinical skills essential for medical students and residents to master, is the ideal setting for this study. Since the advent of the COVID-19 pandemic, YCMS demonstrated the creativity and flexibility to run 100% virtually.