1101: Community Hospitals Emerge as Models for Disaster Readiness With Rapid Cycle In Situ Simulation

INTRODUCTION: COVID-19 exposed the vulnerability of healthcare systems at all levels Preparedness necessitated collaboration, innovation, leadership, and flexibility to implement risk-mitigating protocols Community hospitals quickly adapted and were active front-line providers during this pandemic Many non-tertiary centres emerged as models for disaster readiness with innovative, real-time strategies that fostered practice change We describe how rapid cycle in-situ simulation contributed to improved safety through identification and prompt resolution of latent safety threats (LSTs) METHODS: A QI initiative involving front-line stakeholders in two large community hospitals was launched focusing on protected code blue and pre-code scenarios In-situ simulations were adapted to multiple wards, including the emergency department, labour and delivery, general medicine, intensive care, diagnostic imaging, the operating room and post anesthetic care unit, the coronary catheterization lab, and renal dialysis LSTs included concerns related to the protected code blue resuscitation and those unique to individual department environments Real-time solutions were adopted and rapidly disseminated through both institutions RESULTS: Over a three-month period (March to May, 2020), we conducted over 30 in-situ simulations LSTs included breaches in donning and doffing, lack of clarity in roles and responsibilities, gaps in strategies to minimize aerosolization, barriers for effective team communication, and patient transfer logistics Institution-wide policies were developed in real-time and distributed to hospital staff after each cycle to promote immediate knowledge translation This created a collaborative, evolving protected code blue policy that improved healthcare worker confidence, readiness and safety CONCLUSIONS: Community hospitals are ideal settings for disaster readiness as they can quickly design QI models, integrate results and modify processes in real time Rapid cycle in-situ simulation empowered two community hospitals to expeditiously implement practice changing policies during the peak of the COVID-19 pandemic This is a robust example of an easily adoptable community-based QI strategy that effectively fosters rapid institutional change when required to weather the storm of a natural disaster