Journal of Education and Teaching in Emergency Medicine

Audience: This simulation is intended for interprofessional clinical decision unit (CDU) teams. 

Introduction: Emergency department (ED) observation units or clinical decision units (CDU) are a common care model found in many hospitals due to their ability to provide high-quality care and reduce length of stay while also minimizing costs.^1,2,3 Despite initial clinical stability, deterioration while in the CDU may occur. Due to the unique environment of the CDU, it is essential that the interprofessional team is prepared to manage unstable patients; yet there is minimal literature on how to best train observation unit teams. 

Educational Objectives:  By the end of this simulation session, learners will be able to: 1) prioritize and coordinate team-based tasks within the CDU environment upon recognizing patient decompensation and cardiac arrest, 2) optimize clinical decision unit (CDU) team member roles and interprofessional communication, 3) adapt resuscitation principles in the resource-variable setting of a CDU to manage a critically ill patient.

Educational Methods:  This is run as an in-situ simulation with an interprofessional team as an experiential learning intervention. The in-situ format enables exploration of the team-specific and unit-specific context during the debrief. 

Research Methods: Participants completed a pre- and post-self-assessment via QR code along with responses to three program evaluation questions. 

Results: Twenty-five team members participated in six in-situ CDU simulations. On the pre-assessment, participants had a median of 4 (scale of 1- strongly disagree to 5 - strongly agree) across all categories including confidence in their role during a Code Blue, roles of team members, team priorities, trust in team members, equipment location, and comfort in providing hand-off. On the post-assessment, team priorities and trust in team members increased to a median of 5. In the program evaluation, participants found the experience valuable, particularly the debrief.  

Discussion: Team members started the simulation with confidence in cardiac arrest management, but participation increased their understanding of trust in team members and team priorities within the CDU context. This simulation and debrief session could help support team performance during cardiac arrest within the distinct clinical and interprofessional environment of the CDU.