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. 2023 Jan 29;19(1):9.
doi: 10.1186/s13223-023-00764-9.

Simulation-based education to improve management of refractory anaphylaxis in an allergy clinic

Ana M Copaescu  1   2   3 , Francois Graham  4   5 , Nathalie Nadon  6 , Rémi Gagnon  7 , Arnaud Robitaille  8 , Mohamed Badawy  9 , David Claveau  10 , Anne Des Roches  4 , Jean Paradis  4 , Matthieu Vincent  11   12 , Philippe Bégin  4   5
Affiliations

Simulation-based education to improve management of refractory anaphylaxis in an allergy clinic

Ana M Copaescu et al. Allergy Asthma Clin Immunol. .

Abstract

Background: High-fidelity simulations based on real-life clinical scenarios have frequently been used to improve patient care, knowledge and teamwork in the acute care setting. Still, they are seldom included in the allergy-immunology curriculum or continuous medical education. Our main goal was to assess if critical care simulations in allergy improved performance in the clinical setting.

Methods: Advanced anaphylaxis scenarios were designed by a panel of emergency, intensive care unit, anesthesiology and allergy-immunology specialists and then adapted for the adult allergy clinic setting. This simulation activity included a first part in the high-fidelity simulation-training laboratory and a second at the adult allergy clinic involving actors and a high-fidelity mannequin. Participants filled out a questionnaire, and qualitative interviews were performed with staff after they had managed cases of refractory anaphylaxis.

Results: Four nurses, seven allergy-immunology fellows and six allergy/immunologists underwent the simulation. Questionnaires showed a perceived improvement in aspects of crisis and anaphylaxis management. The in-situ simulation revealed gaps in the process, which were subsequently resolved. Qualitative interviews with participants revealed a more rapid and orderly response and improved confidence in their abilities and that of their colleagues to manage anaphylaxis.

Conclusion: High-fidelity simulations can improve the management of anaphylaxis in the allergy clinic and team confidence. This activity was instrumental in reducing staff reluctance to perform high-risk challenges in the ambulatory setting, thus lifting a critical barrier for implementing oral immunotherapy at our adult center.

Keywords: Allergic emergencies; Allergy clinic; Ambulatory setting; Anaphylaxis; Anaphylaxis management; High fidelity simulation based-learning; Medical education; Teamwork.

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Conflict of interest statement

RG—Investigator for Boehringer Ingelheim, Astra Zeneca, Merk, GSK, Novartis, Stallergene, DBV, Sanofi, Green Cross, Advisor committee for Novartis, Aralez, Mylan, ALK, Presenter for Merk, Pfizer, Astram Aralez, Pediapharm, Novartis. MV—member of Ezdrips (non-profit organization). PB–PB received research grants from Novartis, Sanofi, Regeneron and DBV Technologies and personal fees from Novartis, Aralez, Sanofi-Genzyme, Bausch Health, ALK, Astra-Zeneca, Valeo and Pfizer, unrelated to this work. AC, FG, NN, AR, MB, DC, AD, JP—No conflict of interest.

Figures

Fig. 1
Fig. 1
Sequence of activities
Fig. 2
Fig. 2
Variation in confidence level before and after the simulation activity. Dots indicate individual participants’ answers. P-values were calculated using the Wilcoxon matched-pairs signed rank test
Fig. 3
Fig. 3
Participant’s feedback. The error bars correspond to the 95% confidence interval around the average response
See this image and copyright information in PMC

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