Multidisciplinary in-situ simulation to evaluate a rare but high-risk process at a level 1 trauma centre: the “Mega-Sim” approach

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Fig. 1
Average response score to Likert scale questions (1 = strongly disagree, 5 = strongly agree).

Table 1

Pre-identified quality issues: successes, latent safety hazards, and change interventions

Component	Successes	Latent safety hazards (identified by direct observation or debriefing)	Change interventions
TIP CPG: Pre-hospital and ED care	Appropriate implementation of Pre-hospital TTA Maternal positioning, investigations Fetal assessment equipment Appropriate use of CPG Switchboard support to call consultants	Unclear TTA criteria Drug doses in pregnancy not specified Physician CPG not specific enough	Clarification of TTA criteria on CPG Pregnancy-appropriate drug doses added to CPG Physician CPG revised
TIP CPG: OR care	Appropriate support of BCWCH MFM/neonatology Accessible by phone in a timely manner THAU nurses to bring supplies/medications	Unclear maternal/neonatal hospital transfer criteria Difficulty accessing all delivery medications Inconsistent caesarean section training among all trauma surgeons	Clarification of transfer criteria on CPG Delivery medication “kits” now stocked in ED, ICU, OR and THAU Trauma surgeons to develop strategy for skill maintenance
Code Pink algorithm	Appropriate use of Algorithm to guide care of unfamiliar situation Multidisciplinary consultants as recommended	Improperly stocked infant warmer Inconsistent neonatal resuscitation training among Code Pink nurses Lack of clarity about anesthesia involvement at Code Pink	Monthly checks by Code Pink team On-site neonatal resuscitation training program implemented for Code Pink nurses Multi-departmental commitment for anesthesia at all Code Pink

BCWCH = British Columbia Women’s and Children’s Hospital; CPG = clinical practice guideline; ED = emergency department; ICU = intensive care unit; MFM = maternal-fetal medicine; OR = operating room; THAU = trauma high-acuity unit; TIP = trauma in pregnancy; TTA = trauma team activation.