Enhancing organisational preparedness for primary care paediatric emergencies through in-situ simulation

Introduction
I clearly remember managing a medical emergency in General Practice, it felt different to hospital setting, no cardiac arrest team, no resuscitation area, successful management depended on our GP team and resources.
Primary care emergencies are not rare, but are uncommon, it is difficult to gain and maintain skills from direct experience, but we must learn how to manage life-threatening emergencies. Simulation is useful to train for high acuity low opportunity events, in-situ simulation (ISS) helps retain clinical contextuality. Existing research has evaluated the potential of ISS but has been limited by outcome measures such as improved participant confidence.
Methods
We used Cultural Historical Activity Theory (CHAT) as a systemic framework to extend the use of ISS, enabling it to drive organisational transformation alongside practitioner development. We facilitated a programme of ISS, a GP multidisciplinary team engaged in simulated paediatric emergencies, systemically analysed organisational preparedness and implemented new ways of working.
Results
Through CHAT facilitated discussions subjects considered issues beyond their individual performance that might not otherwise have come to light. They began to understand the systemic nature of their daily activities, identified contraindications, developed, and implemented new work practices helping transform practice preparedness for managing paediatric emergencies.
Discussion
This programme helped guide the team in the best direction of providing team-based patient centred emergency care, orientated towards the individual and community. This work demonstrates how ISS translated evidence to real world practice and the potential for GP practices to upskill using CHAT and ISS to bridge the theory- practice gap.