Simulation makes every second count for trauma patient

Departments, community team up to improve surgical pathway

Story by Kathleen Deman | Photo supplied

For a critically injured patient, the difference between life and death is often measured in minutes. Traditional pathways require all patients, even those in critical condition, to pass through the emergency department (ED) for registration and triage before reaching the operating room (OR). For patients requiring immediate surgery, these extra steps may delay care.

This urgency drove a new simulation of Alberta Health Services’ Direct to Operating Room (DtOR) pathway for critically injured patients who require immediate surgery. It aims to shorten the time to surgical intervention by bypassing the ED and moving directly from the helipad to a waiting OR, when clinically appropriate.

“The DtOR pathway is a critical innovation in trauma and emergency surgical care,” says Kelly Osinski, adult trauma coordinator. “It allows select critically ill patients, requiring immediate life-saving intervention, direct access to the operating room."

A simulation held on June 26 reflected a multi-departmental and community-wide effort. It brought together: the eSIM (Educate, Simulate, Innovate, Motivate) provincial simulation program; STARS air ambulance; Referral, Access, Advice, Placement, Information & Destination (RAAPID); and teams from the Foothills Medical Centre (FMC) including trauma, OR, anesthesiology, ED, admitting and security.

This simulation involved a 28-year-old patient who arrived at the Brooks Health Centre’s ED with a single stab wound to the chest. An ultrasound suggested a pericardial effusion, a potentially life-threatening accumulation of blood around the heart. In response, the Brooks ED activated a “Red Transfer” process through RAAPID, thus setting in motion the carefully choreographed DtOR pathway.

“It’s rare that we’re able to get this many different groups together for one learning event,” says Erin Young, FMC simulation consultant. “Individual teams see just a piece of the process in real life, but this simulation gave everyone the full picture and that builds mutual understanding and trust.”

From the first phone call to the moment the simulated patient was wheeled into the OR, the simulation followed the real-world process: RAAPID connected the sending physician with Calgary’s Trauma Team Leader. The STARS crews prepared for rapid transport and coordinated arrival timelines. From there, the FMC OR team confirmed they had capacity and began preparing the surgical suite, while security ensured a clear and safe path from the rooftop helipad directly into the OR.

The provincial eSIM program led the design and coordination of this large-scale trauma simulation, which helped teams to safely test systems, improve communication and strengthen patient-care pathways. Their expertise ensured the scenario recreated the real-world challenges of trauma care.

“Testing the processes of high-acuity, low-occurrence events in a simulated environment is critical for safe and successful process design — and having eSIM as a part of the development has been invaluable,” says Dr. Arthur Tse, STARS medical director, Calgary. “Their expertise in coordinating a large number of stakeholders and providing systems-based insights in this project has been key to a rigorous multidisciplinary development.”

Rather than a performance test, this simulation was intended as a shared learning experience to promote teamwork, reflection and growth. It offered a valuable opportunity to practise coordination in a realistic, yet controlled environment. Participants reinforced best practices, gained a clear view of the care pathway and identified opportunities for improvement. It also strengthened teamwork, built confidence and enhanced trauma care delivery.

“The ability to simulate the process helps new teams get involved, feel comfortable and integrated in the process, which aids the change process and end goal of safe and quality care,” adds John Montpetit, RAAPID provincial director.

The exercise also provided opportunities to test a new workflow in Alberta’s provincewide electronic health record system, clarifying paging protocols and notification steps to improve the consistency of verbal handovers. Participating teams highlighted the benefit of using standardized language, such as “ready to transfer care,” to support smoother transitions and promote a shared understanding.

As FMC simulation consultant Kiri Blackwell explains, “This wasn’t about finding problems, but rather about practising excellent care together.”

Healthcare Simulation Week (Sept. 15-19) is a reminder of the value in proactively testing systems in a controlled and safe environment. The DtOR exercise demonstrated how simulation can foster alignment, enhance clarity and communication, build team confidence, identify opportunities for improvement and ultimately contribute to saving lives.