Building a culture of simulation in a paediatric Emergency Department

Jane Cichero1, Dr Nichola  Concannon2, Dr Linda Durojaiye3

1Sydney Children’s Hospitals Network, Randwick, Randwick, Australia, 2Sydney Children’s Hospitals Network, Randwick, Randwick, Australia, 3Sydney Children’s Hospitals Network, Randwick, Randwick, Australia

Simulated learning environments (SLE’s) have become integral to many education programs in healthcare today. Since 2014 the Sydney Children’s Hospital Emergency Department (ED) has supported nursing and medical simulation lead positions to facilitate the development of a simulation education program to support learning in the ED and inform practice.

Our comprehensive ED Simulation program includes multidisciplinary in-situ scenarios and one day team training courses, triage, advanced nursing practice and clerical scenarios,  clinical skills teaching, faculty training and mentoring, and senior ED staff communication and challenging conversation scenarios.

Latent errors and knowledge gaps revealed during sessions are recorded and tabled at the ED Quality and Safety Committee. In addition, any significant clinical incidents inform the development of new systems or tools which are tested and rehearsed in SLE’s.

Evaluations utilise a 5 point likert scale with free text option have been extremely positive across all aspects, the majority indicating scores in the two highest bands.

Defined quality data has been measured and patient safety initiatives have been developed.

Faculty training and a mentoring model has widened the pool of skilled simulation educators resulting in a sustainable workforce to support a culture of simulation in ED.

The ED simulation program has provided a positive impact on the culture and safety in our ED. The SLE’s are consistently used to inform practice, develop and check clinical tools and systems and improve care for patients and families in the ED. Ongoing feedback through the quality cycle continues, further improving and refining these tools/systems.

After two years there is a perceived difference in staff attitude to simulation, with regular requests for inclusion in future SLE events, a testament to the value staff now place on this type of learning, demonstrating that faculty have been successful in creating a safe learning environment for all.


Jane Cichero has been a Paediatric Nurse Educator since 2002. Jane holds a Graduate Certificate of Paediatrics, Paediatric Critical Care and a Graduate Diploma of Clinical Teaching. Jane has extensive experience in general paediatric nursing, paediatric intensive care and paediatric emergency nursing. Her passion for education incorporates a passion for simulation. Jane completed the Harvard Medical Simulation as a Teaching Tool Instructor Course in 2011 and has continued to develop skills and knowledge in the world of simulation . Her current role as Nurse Lead for Simulation in the Emergency Department at Sydney Children’s Hospital, Randwick enables her to promote and utilise simulation in many aspects of multidisciplinary education and quality and safety in emergency care.