SAME: Safety during Ambulatory Medical Emergencies - An Evidence-Based Practice Project

Purpose: Enhance team member (TM) knowledge, confidence, and readiness when responding to an ambulatory care medical emergency.
Background: With increasing healthcare demands and over one billion annual outpatient visits nationwide, ambulatory care TM are asked to manage more acute patients, increasing the risk of an emergency event in the clinic. It is critical that TM are prepared to intervene when emergencies occur. Creating standardized in-situ training for a variable staffing mix is a challenge and no standardized training process exists. Evidence has shown that education and in-situ simulation improve TM readiness to respond to emergencies.
PICO question: Among ambulatory care sites (P), do education and in-situ simulation (I) improve confidence and readiness (O) of team members to respond to patient emergencies when compared to no intervention (C).
Methods: Using the Johns Hopkins nursing evidence-based practice framework to guide evidence translation, this quality improvement pilot project implemented an in-situ training at four ambulatory care sites which included primary care, pediatrics, general surgery, and health equity clinics. The team partnered with an experienced simulation specialist and attended a train-the-trainer session to implement this training at the selected sites. In addition, a curriculum was developed that focused on myocardial infarction and syncope/falls scenarios, which are two common emergency incidents that occur in the clinics. Participants were asked to complete an anonymous pre- and post-survey to measure knowledge about emergency situations and confidence and readiness when responding to emergencies in their workplace. After the completion of the two scenarios and debriefs, participants were provided with a tip sheet summarizing the training as a future educational tool.
Outcomes: Simulations were performed over a 2-month period and included both clinical and nonclinical TM reporting various amounts of time in their role. Descriptive analysis was conducted to determine project outcomes. Over 78% of participants had some form of life support certification. From pre-survey to completion of the two simulations and post-survey, participants reported increased readiness to recognize a medical emergency. Participants expressed increased readiness to provide essential information to other TM during a medical emergency and increased confidence in finding and correctly using equipment in their clinic.
Lessons learned: The project highlighted the value of evidence-based practice in creating effective training programs. The "train-the-trainer" model proved essential for successful implementation. Additionally, awareness of existing emergency resources was enhanced, while gaps in education and resources were identified for future improvement.
Conclusion: Positively engaging TM in a psychologically safe learning environment can promote increased knowledge, confidence, and readiness, which potentially creates a safer clinical environment.
Implications for nursing practice: Project results indicate in-situ educational interventions improve confidence and readiness of ambulatory care TM responding to medical emergencies. A scaled implementation across ambulatory care clinics is recommended.