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Author Notes:

SLMW: smuretw@emory.eedu

The authors are deeply grateful to the frontline clinicians and leaders at the Emory University School of Medicine and Emory Healthcare who courageously and brilliantly care for those stricken with COVID-19 disease.

The authors declare no conflict of interest.


Research Funding:

This work did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.


  • Betacoronavirus
  • Coronavirus Infections
  • Georgia
  • Humans
  • Infection Control
  • Infectious Disease Transmission, Patient-to-Professional
  • Operating Rooms
  • Organizational Innovation
  • Pandemics
  • Patient Care Team
  • Personal Protective Equipment
  • Pneumonia, Viral
  • Quality Improvement
  • Simulation Training

In Situ Simulation Enables Operating Room Agility in the COVID-19 Pandemic.


Journal Title:

Annals of Surgery


Volume 272, Number 2


, Pages e148-e150

Type of Work:

Article | Final Publisher PDF


As COVID-19 infections soar worldwide, surgical teams must quickly adapt to care for the COVID-19-positive patient in the operating room (OR). This challenge comes in the face of constant change in data and conditions, reliable evidence yet to emerge, shortages of personal protective equipment (PPE), uncertainty due to lack of testing equipment and capacity, and unprecedented strain on caregivers, hospital systems, and resources.1 Agility is essential not only to resilience when environmental threats arise, but also to the expeditious design and launch of a new process itself.2 We sought to create an agile process to optimize teamwork and care, and to proactively identify and mitigate risks for patients and staff. Further, we needed a process that could undergo rapid change, enhance safe and effective team performance, and be adapted and replicated across a large healthcare system that serves nearly 75,000 inpatients a year. Immersive, high-fidelity simulation conducted in situ in the actual clinical environment can be used to train interprofessional teams and to enhance safety through design, testing, and error-proofing new processes, devices, and facilities.2,3 We aimed to use an iterative, collaborative approach integrating in situ simulation and rapid cycle quality improvement to confront the COVID-19 outbreak for the COVID-19-positive patient in the OR.

Copyright information:

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