Practice Makes Perfect
Using simulated scenarios to train front-line staff in the COVID-19 response.
Tucked away in an unassuming annexe at the back of the John Radcliffe Hospital you will find a powerhouse at the centre of training NHS staff on the COVID-19 front line. This is OxSTaR (Oxford Simulation, Teaching and Research), the University of Oxford’s state-of-the-art medical simulation, teaching and research facility. This unit, led by Dr Helen Higham, is part of the Nuffield Division of Anaesthetics in the Nuffield Department of Clinical Neurosciences. It embodies the incredible impact that can be achieved when robust research meets clinical practice — and never more so than in a global crisis such as the one in which we now find ourselves.
For 12 years, OxSTaR has been running simulated scenarios — complete with highly realistic functioning models of patients known as manikins — to understand and improve how healthcare professionals work together and interact with their environment and equipment. They have used the insights gained to provide training across Oxford University Hospitals (OUH). Recent weeks have seen them rise to the unique challenge of supporting front-line clinical staff during a pandemic. Helen is full of praise for everyone involved in this effort, particularly the members of her core team: Rosie Warren, Alan Inglis, Russ Sinclair, Charlie McDermott, Wendy Washbourn and Paul Hambidge. This outstanding example of the University and OUH working in partnership has also hinged on the enthusiastic engagement of OxSTaR’s faculty (largely anaesthetics and intensive care consultants and trainees), and support from OUH Infection Prevention and Control team, Corporate Education, the Chief Medical and Nursing Officers and Oxford Medical Imaging.
COVID-19 presents new problems for teams in intensive care units and emergency departments. OxSTaR’s training has been invaluable not only to healthcare staff returning from retirement or being redeployed, but also for seasoned professionals such as Helen herself. She had what she called the ‘dubious honour’ of being part of the first intubation team to intubate a COVID-19 patient in the John Radcliffe Hospital. Her approach to this familiar process of inserting a tube into a patient’s airway was tinged with nervousness in this new situation. But these nerves were mitigated by the fact that she had just received training and practised this specific scenario several times. Endowing clinicians with this ability to fall back on what they have learnt when the pressure is on is OxSTaR’s trademark and key aim.
Training staff in new Covid-19 procedures
The first phase of OxSTaR’s involvement in the coronavirus crisis was developing educational materials about how to put on and take off personal protective equipment (PPE) safely. In the first ten days they had trained 195 trainers to train other people within OUH — not only clinicians but also ancillary staff such as cleaners. This adaptation of OxSTaR’s existing ‘Train the Trainer’ model ensures that best practice is disseminated across OUH quickly and at scale.
The second phase of work involved training in intubation and extubation (inserting and removing tubes into airways to aid breathing), and turning patients onto their fronts to assist breathing (known as ‘proning’).
A third phase saw the OxSTaR team honing their renowned ‘human factors’ training — equipping medical teams to work together in stressful situations to maintain patient safety. This involved simulating COVID-19 ‘patient pathways’, working out the best way to transfer people between different clinical areas such as critical care to wards, radiology suites or theatres. The team also played an integral role in the development of bespoke checklists and standard operating procedures for the care of COVID-19 patients in theatres and critical care. NHS staff in intensive care, theatres, obstetrics and paediatrics teams have had the opportunity to practise scenarios again and again in order to make sure that in this time of COVID-19 risk, patients and staff are kept as safe as possible.
We are very lucky to have OxSTaR. Led by Helen, the team at OxSTaR have provided valuable training to our staff in these challenging circumstances. OxSTaR is an incredibly important part of our education agenda.
Professor Meghana Pandit, Chief Medical Officer at OUH, and Associate Fellow at Green Templeton College.
Early on in the whole process, the OxSTaR team made a decision to upload all their training materials onto their website so that staff who were off-site or isolating at home could get up to speed before coming to work. The result is a growing suite of checklists, webinars, videos and pdfs. The team promoted this resource by means of physical posters with QR codes around OUH sites, as well as sending emails and posting on Twitter. This comprehensive information campaign means that OxSTaR’s COVID-19 material has now been used by medical teams all over the world. Since the launch of the special pages on 15 March 2020 there have been over 10,300 hits by over 6,400 new users in 73 countries. Helen cites a grateful tweet from a medic in the Philippines who had come across the OxSTaR video about how to respond to a cardiac arrest in a COVID-19 patient who has been turned on to their front.
University students get involved
Bronwyn Gavine is a doctor from South Africa, who is in Oxford to study for a DPhil. She is a Rhodes Scholar in her first year at the Nuffield Department of Clinical Neurosciences, looking at the effects of transcranial direct current stimulation on the part of our brain that controls movement.
When it became clear in early March that the effect of the pandemic would be widespread and potentially devastating, she says she ‘desperately wanted to help and contribute to the response’.
Just 24 hours after asking her supervisors and Head of Department Professor Kevin Talbot how she could help, she met with Helen and the OxSTaR team for a whirlwind induction and has now been in the thick of it for over a month. She has been helping to train medics, develop OxSTaR’s guidelines and checklists, and upload materials to the dedicated webpages.
Bronwyn remembers ‘walking into the hospital and feeling like there was a thick blanket of anxiety — there was so much uncertainty about what would happen — we were trying to clear the path to make it safe and get to higher ground’. She rates the OxSTaR team and their approach very highly, explaining how everyone very quickly felt supported and appreciated. ‘The whole experience has reminded me how rewarding it is to be part of a team that not only does training but also helps to guide best practice. I hope to continue supporting OxSTaR even once I’ve gone back to my DPhil full time, and I hope to continue to work on aspects of clinical leadership especially once I return to clinical work.’
Testing new devices in the fight against Covid-19
The facilities at OxSTaR have also proved useful for testing new devices coming on board in the fight against coronavirus. Researchers at the University of Oxford joined up with King’s College London to respond to the UK Government’s ventilator challenge. The result was the OxVent ventilator, which the team were able to demonstrate on the manikins in the simulation suite. This enabled their project to move on to the next stage (at the time of writing it is currently in the final stage of testing by the Medicines and Healthcare Products Regulatory Agency).
Most recently, a team from Formula 1 has been in touch with OxSTaR to organise testing of a perspex box to protect staff when they are carrying out aerosol-generating procedures on patients that might expose them to a large viral load. Chinese colleagues shared the original box design, which the Formula 1 team are now adapting so that it is easier to store and clean.
In addition to training and testing, OxSTaR has also been functioning as an equipment library, loaning airway heads, manikins, and podcasting hardware to teams across OUH.
Improving best practice for the future
The legacy of this astonishing period of intense work will be long-lasting. Helen says that new relationships across and beyond the hospital have been forged, and old ones cemented. Never has the value of simulation-based education been more obvious in healthcare: there will be changes to best practice brought about by this crisis, which will ensure that our NHS is well equipped to enhance patient and staff safety well into the future.
Written by Jacqueline Pumphrey (@NovelJacqueline), Communications and Public Engagement Manager, Nuffield Department of Clinical Neurosciences.
What next?
Follow us here on Medium where we’ll be publishing more articles soon.
Oxford’s advice and updates on coronavirus (Covid-19) and Oxford’s latest research on coronavirus.
Want to read more? Try our articles on: Covid-19 Impact Monitor reveals UK population moves drops by 98%, FBI follows Oxford academic’s guide to beat the Zoom-bombers or 100 years of Oxford’s amazing women.
Are you a member of the University who wants to write for us on Medium? Get in touch with us here with your ideas: digicomms@admin.ox.ac.uk.
