Table 2 Simulation roles, workflow steps, and objectives: Tympanostomy with tonsillectomy & adenoidectomy

ORL Surgeon (6)

Physician Assistant (9)

Nurse Practitioner (3)

Clerk (1)

• Patient arrives for a surgical consult visit (Otolaryngology Clinic Location)

• Patient is checked in

• Vitals documented (height, weight, allergies)

• Place case request for surgery (2 procedures)

• Place pre-op and post-op orders for the appropriate phase of care

• Obtain surgical consent (Physician Assistant, Surgeon, and patient representative)

• Update surgical consent

• Tools and technology to allow for concurrent workflow between Physician Assistant and Surgeon (i.e., orders/consent)

• Efficient processes and workflows with the EHR

• Communication with patients and families

• Environmental impacts related to EHR workflow (documentation in patient room versus clinician office)

Pre-op Nurse (4)

-participants completed both pre-op and post-op nursing tasks

• Moves patient into the Pre-op department within the system & assigns them a bed

• Release signed and held orders

• Complete pre-op documentation (i.e., vitals, head to toe, patient belongings)

• Review consent form

• Complete the pre-op checklist

• Documentation efficiency

• Concurrent documentation with Anesthesia or Surgeons

• Roles and responsibilities for patient movement and other tasks

Anesthesiologist (3)

Nurse anesthetist (2)

• Review the history

• Review the pre-op documentation and pre-evaluation

• Place post-op orders for recovery

• Create the Anesthesia note

• Obtain consent

• Move patient into intra-procedure

• Anesthesia Checklist

• Intra-procedure documentation (induction, assessments, positioning)

• Intubate patient (document airway)

• Insert an IV line (document)

• Document medication administration

• Stop anesthesia

• Documentation efficiency

• Tools and technology to inform others of Anesthesia tasks (i.e., IV lines and airways)

• Ease of documenting medications

• Concurrent documentation by Nurse anesthetist and Anesthesiologist

• Roles and responsibility change for orders placed by anesthesia

• Environment—Portable computer workstations for anesthesia and all roles placement

Intra-op Nurse (6)

• Document surgical counts (initial and closing) for both procedures

• Move the patient into the Operating Room

• Complete the timeout checklists

• Complete the intra-procedure documentation (site preparation, positioning, equipment: electrosurgical grounding)

• Document the intra-op medication administration by the surgeon

• Staff shared awareness of patient readiness for surgery

• Roles and responsibilities for patient movement and other tasks

• Documentation efficiency for quick turnaround cases

• Tools for medication administration workflows in the Operating Room

Post-op Nurse (6)

• Update patient location to the PACU and assign the patient a bed

• Receive handover from the Anesthetists

• Release the signed and held orders

• Remove the IV line

• Complete post-op documentation (i.e., vitals, head to toe, patient belongings)

• Complete discharge education & prepare the patient for discharge

• Roles & responsibilities for patient movement and other tasks

• Handover process and tools

• Documentation efficiency

• Concurrent documentation with Anesthesia or Surgeons

• Discharge process