Title : Turn the heat around: Quality improvement in malignant hyperthermia response through in-situ simulation
Abstract:
This session will describe a quality improvement initiative designed to strengthen perioperative team preparedness for malignant hyperthermia (MH), a rare but life-threatening aesthetic emergency. The project implemented in situ interprofessional simulation using Rapid Cycle Deliberate Practice (RCDP) within an academic medical center’s operating rooms and post-anaesthesia care unit.
Description of Team: A multidisciplinary team was formed to improve malignant hyperthermia (MH) preparedness within the perioperative setting. The team consisted of perioperative nurses, anesthesiologists, clinical educators, simulation specialists, and leaders from the orthopedic operating room, post-anesthesia care unit, and simulation center. This interprofessional team brought diverse clinical perspectives and operational insights to the project’s design, execution, and evaluation.
Preparation and Planning: The project began with a comprehensive review of the perioperative environment, including a baseline in situ MH drill to assess existing practices and staff familiarity with MH protocols. The team evaluated the institutional MH policy, benchmarking it against current national guidelines and evidence-based recommendations. Gaps in team response and clinical workflow during MH crises were identified, prompting policy revisions and the development of targeted training objectives. Planning also included the creation of a drill-specific MH cart to enhance realism, the design of orthopedic-focused MH simulation scenarios, the development of performance metrics aligned with protocol adherence, and coordination of faculty training for simulation facilitation. Support from perioperative leaders and frontline staff was actively secured to ensure engagement and logistical feasibility.
Assessment: Baseline in situ assessments revealed limited staff familiarity with MH protocols, low confidence in responding to MH events, and unclear team roles. Data from observations, debriefings, and staff surveys highlighted the need for targeted, hands-on training to improve clinical response and interprofessional coordination.
Implementation: The project used the Institute for Healthcare Improvement Model for Improvement and Plan-Do-Study-Act cycles, integrated with RCDP. The Donabedian model and NLN Jeffries Simulation Theory guided evaluation and simulation design. Five high-fidelity, in situ simulations were conducted over two months. Performance was assessed using a 32-item MH protocol checklist. Two facilitators provided real-time evaluation and debriefing, while two independent evaluators reviewed recordings to ensure interrater reliability.
Outcome: Statistically significant improvements were observed. Time to dantrolene administration improved from 456 to 206 seconds (p = .018), and time to initiate cooling decreased from 304 to 115 seconds (p = .011). MH cart retrieval and bolus completion times also improved (p = .043). Team performance scores increased from 14.51 to 30.75 (p < .001, d = 4.53). Staff confidence and satisfaction improved post-training, supporting the effectiveness of RCDP in enhancing preparedness for MH crises.
Implications for Perioperative Nursing: This project highlights the impact of combining simulation-based training with policy and process improvement. RCDP promoted rapid skill acquisition, improved communication, and increased role clarity. Perioperative nurses played a vital role in leading and sustaining this work. Annual MH simulations, ongoing education, and expanded participation from key stakeholders can strengthen institutional readiness and enhance patient safety during high-risk, time-sensitive perioperative emergencies.
