Preparing anaesthesiologists to safely care for patients with COVID-19: an observational study of a simulation course

Abstract

Background: Anaesthesiologists are at high risk for exposure to SARS-CoV-2. We describe the development, implementation and efficacy of a high-fidelity simulation course for anaesthesiologists in response to this threat.
Methods: This is an observational study of preparedness conferred by a simulation course. The following four knowledge gaps were identified: i) personal protective equipment (PPE) selection and donning/doffing; ii) operating room and anaesthesia machine turnover; iii) routine and difficult airway management; and iv) emergent airway management and Advanced Cardiac Life Support (ACLS) protocols. Four simulations were developed and offered to faculty, residents and Certified Registered Nurse Anaesthetists (CRNAs) at an anaesthesiology department. A survey estimated prior knowledge and assessed knowledge gained after the course.
Results: Prior to the simulations, 27% and 26% of the participants estimated ability, respectively, to don and doff PPE, compared to 99% of the participants who demonstrated knowledge after the simulations: donning, odds ratio (OR) = infinity (19.6, infinity); doffing, OR = infinity (19.9, infinity). Prior to the simulations, 28% of the participants estimated knowledge specific to airway management; while after the simulations, 84% of the participants identified correct principles of airway management (OR = 9.1 [4.3, 20.2]). Prior to the simulations, 15% of the participants estimated knowledge of principles guiding emergency airway management and/or ACLS protocols, compared to 94% of the participants who correctly identified those principles after the simulations (OR = infinity [21.9, infinity]). Only 18% of clinicians estimated that they were competent prior to the simulations, while 89% of clinicians demonstrated competency on the written survey after the simulations (OR = 37 [10.8, 212]).
Conclusion: Our results suggest that this simulation course effectively prepared anaesthesiology faculty, residents and staff to select appropriate PPE, and don and doff it, as well as apply best practices during airway management and ACLS  protocols.