International Journal of Healthcare Simulation

Background:

In November 2020, the first COVID-19 vaccine for the UK had been approved. We were subsequently tasked with the rapid development of vaccination clinics. Two COVID-19 vaccination clinics in suitable spaces within the University Hospitals Bristol and Weston NHS Ft were planned, across two different hospital sites (25 miles apart), to be operational within 7 days. Changes to both pharmaceutical and national guidelines were altering by the hour.

Aims:

The key driver for this fast-paced change was to ensure vaccines were delivered as soon as available to Bristol-based health and social care staff.

Methods:

A process map outlining the vaccination journey established in the local public vaccination site was the starting point to understand how to efficiently, effectively and safely deliver vaccines. Hospital sites for both clinics were identified, and work began immediately to vacate those rooms and establish both the infrastructure and personnel to run the large-scale clinics. Simulation Lead Educator involvement during the first days of planning was essential and at each stage of the process mapping.

Simulation Round 1:

full-scale simulated vaccine clinic in the newly designed rooms on one site

standardized patients (actors) briefed as receiving the simulated vaccine

key staff in roles – administrators, pharmacy, vaccinators

debrief focussed on latent threats, agreeing immediate changes to be tested in the next round

patient experience feedback from the standardized patients

Simulation round 2:

immediate re-run of the simulated clinic

solutions identified in Round 1 were applied and tested

rapid improvements to the process mapping, ergonomics, clarity of roles and timings for clinic appointments were able to be made

Simulation round 3:

Round 3 took place on the second site a few days later

lessons learnt from the first two stages being shared and translated within the new site

essential safety and efficiency issues were explored and lessons learnt applied to the clinic

Results:

The three rounds of simulation systems testing identified a number of latent threats and process mapping alterations which were implemented immediately, with solutions being tested on the spot. The vaccination clinics opened, administering over 500 vaccines per day across a 4-month period. The team involved continued to adapt processes and environment to suit the constantly changing guidelines and ensure safe practice.

Implications for practice:

Simulation is an adaptive and responsive tool in systems testing, process mapping and implementing solutions within a high-pressured and time-restricted environment.