Incorporating Clinical Simulation with Hands-on Practice for Inter-hospital and Intra-hospital Transfer of Critically Ill Adult Patients in Hong Kong East Cluster

Introduction

In 2024, the Hospital Authority Head Office (HAHO) developed new Guidelines and Checklists on Inter- and Intra-hospital Transport of Critically Ill Adult Patients, aiming to promote safety and prevent incidents arising from critically ill transportation and oxygen device use. Hence, in September 2024, the Nethersole Clinical Simulation Training Centre (NCSTC) created an innovative pilot program focusing on critically ill transport. The objectives were to refresh, consolidate, and enhance the skills and knowledge required for inter- and intra-hospital transport of critically ill adult patients for staff of Hong Kong East Cluster (HKEC).

Learning outcomes included familiarization with inter- and intra-hospital transport guidelines and checklists; competency in categorizing the tiers of critically ill patient transport; assess the risks of transport including signs of respiratory failure, managing emergencies and applying Crew Resource Management (CRM) principles in crisis management.

Description

This 3.5-hour workshop includes1. A lecture that introduced participants to the definitions of critically ill transport categories, the composition and role delineation of transport team members. Documentation of using checklists for inter- and intra-hospital transport of critically ill adult patients was explained. Participants were trained to utilize common modes of portable ventilators, perform safety checks of oxygen cylinders and estimate oxygen requirement during transport. Particularly, the rapid consumption of oxygen in high-flow nasal cannulas (HFNC) and non-invasive ventilation (NIV) was highlighted. Common ventilator alarms were also introduced along with appropriate differential diagnoses;2. A simulation session with 2 scenarios focusing on inter- and inter-hospital transportation was held. Team members delineated roles, prepared equipment, decided on logistics of transport; and tackled clinical emergencies.3. A Hands-on Skill Station for demonstrating safe bed transfer, with the use of Eye-tracking technology, and adopting nasal End-tidal Carbon Dioxide (ETCO2) monitoring with real-life demonstration of the capnography waveforms. An interactive quiz concluded the program.

Discussion

At the end of the course, participants reflected that the training raised their awareness in critically ill patient transport, rating a mean score of 4.79-5.21 out of 6. The overall mean rating of the post-training evaluation scored high, 5.33 out of 6. Participants commented it as a “very good workshop”, “useful revision of the usage of checklist” and “the simulation is well-designed and very informative”.In conclusion, this new training course positively impacted doctors and nurses in the consolidation and acquisition of skills and knowledge for intra- and inter-hospital transport of critically ill adult patients. Future directions include expansion of the scope to all staff and incorporating innovative devices in improving situation alertness.

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