In-situ simulation of CPR in the emergency department - A tool for continuous improvement of the initial resuscitation.

Background: Simulating CPR scenarios in a clinical environment has been described as a method for mitigating latent safety threats. Therefore, we implemented regular inter-professional, multidisciplinary in-situ simulations in the emergency department (ED). Aim: To iterate a line-up and action cards for initial CPR management. To examine the experiences among participants regarding attitudes towards simulation and if they perceived any benefits for their patients after the participation. Method: In 2021 we performed 7 in-situ simulations (15-minute simulation, 15-minute hot debrief) in the ED with the CPR team including doctors and nurses from the ED and anaesthesiology department. A questionnaire was sent to the 48 participants the same day and after 3 and 18 months. Answers were given as yes/no or on a Likert scale 0-5 and are presented as median values with interquartile range (IQR) or frequencies. Results: A line-up and 9 action cards were created. The response rate of the three questionnaires were 52, 23, and 43%, respectively. In total, 100% would recommend the in-situ simulation to a co-worker. Participants perceived that real patients (5 [3-5]) as well as themselves, (5 [3.5-5]), had benefited from the simulation up to 18 months after. Conclusion: Thirty-minute in-situ simulations are feasible to implement in the ED and simulation observations were useful for development of standardised role descriptions for resuscitation in the ED. Participants self-report benefit for themselves as well as their patients.