Change Narrative Abstract - Poster Presentation Only Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting 2023

Background  The acute medical unit of a tertiary metropolitan hospital in Perth has high turnover of adult and older adult presentations.  The Australian Institute of Health and Welfare’s emergency presentation data suggests that patients over the age of 65 constitute 39% of admissions in this setting.  These patients are cared for by a multidisciplinary team including general physicians, geriatricians, nurses, and allied-health staff who are trained to deliver interdisciplinary care.  There is a need for staff of all disciplines to recognise and respond to acute clinical deterioration in older adults whose presentations may remain undifferentiated.  The literature suggests that simulated acute patient deterioration can improve facets of interdisciplinary care.  The authors aimed to develop an embedded simulation programme for junior medical officers and nurses working in this unit. The focus was improving participants’ ability to work effectively as an interdisciplinary team managing patient deterioration, using the personnel, equipment, and environment specific to that unit.

Change  The unit’s medical and nursing staff collaborated with health service staff with expertise in clinical simulation and debriefing to develop a simulation programme.  The result is a comprehensive embedded simulation program able to adapt to the specific needs of the unit, with unit ownership and simulation team support.  The anonymised qualitative data received from participants thus far (Figure 1) has suggested learnings from the simulations are relevant, improve the confidence of staff, and improve interdisciplinary care, communication, and collaboration on the unit.

An audit of medical emergency team calls for older adults on the unit informed clinical scenario selection (Figure 2).  Simulations were conducted in-situ on the unit to improve participants’ access to, and maximise the length of, sessions.  Simulations are integrated in the unit’s teaching calendar for nurses and junior medical officers.  Both tag team and traditional modes of simulation delivery have been utilised.  Anonymised data collection following simulation debriefing allows for continuous refinement and improvement of the sessions.

Learnings  Simulation is a powerful tool to improve interdisciplinary care provision in units who care for older adults.  Interdisciplinary education has benefits to a unit beyond patient care, including staff confidence and collaboration.  Producing high quality interdisciplinary education benefits from collaboration with experts, for example in simulation design and delivery, who are actively guided by participants and their needs. Programs such as this afford greatest opportunity to achieve their aims, remain agile to the needs of those involved, and be sustainable.