Responding to paediatric emergencies in primary care: a novel approach using in-situ simulation

Introduction
Early, effective intervention can be life-saving in dealing with primary care emergencies, yet often general practitioners (GPs) feel unprepared to manage these demanding situations. Paediatric emergencies pose a particular challenge, as treating children requires specific knowledge, skills and equipment. While individually uncommon, a wide range of emergency presentations exist, including anaphylaxis, meningitis and seizures. As a consequence, many GPs encounter paediatric emergencies within their practice, but have limited opportunities to develop direct experience in managing them.

Simulation is well suited to training practitioners to deal with uncommon, hyperacute events, with systematic review evidence linking team training to improved patient outcomes (1).Paediatric emergencies, however, represent complex clinical scenarios whose successful management hinges on a wide range of interacting individual, social and technical factors that are difficult to recreate in simulated settings. The emerging field of in-situ simulation, which retains clinical context and complexity by physically integrating simulation into the healthcare environment, offers a novel and enticing potential solution.

Existing evidence shows that in-situ simulation training is an acceptable and feasible way of developing interprofessional skills in primary care settings (2). Yet much more needs to be known about the impacts of in-situ simulation and how it achieves its effects. The aim of this research is to investigate the use of simulation to improve preparedness to managing paediatric emergencies in primary care, leading to increased understanding of how in-situ simulation supports individual and organisational change.

Description
The proposed research involves two phases. First, I will systematically gather and synthesise existing literature to establish what is known about how in-situ simulation achieves its outcomes. Second, I will develop and implement a programme of in-situ simulation relating to primary care paediatric emergencies. Using participatory research methodology, supported by multimodal evaluation using video, field notes and interview data, I will explore its effects on learning and organisational change.

Discussion
The proposed research, which will be rolled out in Autumn 2020, will achieve direct impact by improving preparedness to provide safe, effective emergency care for children in primary care settings. It will also offer rich insights into the emerging potential of in-situ simulation to stimulate individual and organisational change in response to highly complex, contextualised patient safety problems.