In-Situ Simulation of Intraoperative Emergencies: An Exploration of Prevalence in Certified Registered Nurse Anesthetists’ Workplaces and Satisfaction with the Experience

Abstract

Intraoperative emergencies occur infrequently, and prompt recognition and treatment are essential to prevent adverse outcomes. Previously learned knowledge and clinical skills have been shown to degrade over time. In addition to clinical skills, nontechnical skills such as communication and leadership, are required for optimal patient care. In-situ simulation-based education (SBE), or simulation that occurs in the actual work environment is an effective methodology for teaching both clinical and nontechnical skills. In the operating room, Certified Registered Nurse Anesthetists (CRNAs) are often called upon to recognize and manage these low-volume, high-risk situations. Given the rarity of intraoperative emergencies and the presence of provider knowledge decay, the purpose of this research is to explore the prevalence of in-situ SBE of intraoperative emergencies in CRNAs’ workplace and their satisfaction with such simulations.

A researcher designed 24-question survey was distributed to a convenience sample of actively practicing CRNAs. Of the 2,844 surveys distributed, 133 (4.67%) that met inclusion criteria were returned. Results indicated 66.9% of respondents had participated in some form of SBE in the management of intraoperative emergencies and only 29.6% reported it occurring in their primary place of practice. A majority (65.4%) agreed that previous in-situ SBE helped prepare them in responding to intraoperative emergences and felt satisfied (80.7%) with their experience. Additionally, 76.3% of respondents believe that CRNAs should participate in in-situ SBE in their workplace.

Despite evidence showing the efficacy of in-situ SBE, data from this study indicates that CRNAs have limited opportunities to practice in situ SBE in their primary place of practice. However, the majority of respondents that did participate in in-situ SBE report feeling satisfied with the experience and better prepared to manage infrequently occurring intraoperative emergencies. Information from this study could be used as a foundation for designing unit specific intraoperative emergency scenarios to strengthen both clinical and nontechnical skills in a safe and familiar environment.