From Checklist to Coordination: Redesigning an Airway Tool with VEMS

An emergency department recently realized that their airway checklist—developed over 15 years ago—no longer supported how their team actually worked. It assumed a sequential approach to preparation, while real practice had shifted to parallel, team-based action.

So instead of rewriting and approving it in a meeting room, they turned to simulation as a part of the design process. This is known as translational simulation and VEMS can be a great choice of modality when exploring how to improve processes and systems.

Starting with Practice, Not Theory

Using VEMS teams worked through airway scenarios with:
– A laminated patient
– Equipment and drug visuals
– A checklist in hand

This low-tech setup allowed them to focus directly on how the tool functioned in real team interactions rather than how they imagined it might work. 

The Key Insight: Teams Work in Parallel

It quickly became clear:

The old checklist assumed centralized responsibility for:

1. Equipment
2. Monitoring
3. Drugs
4. Plan

But in reality, sub-teams were actually working independently to achieve a shared goal. All at the same time.

The problem wasn’t the content—it was the structure.

👉 The new checklist needed to support parallel preparation and sub-team coordination.

Testing Under Pressure

Teams trialled new versions of the checklist across scenarios, including:
– Severe anaphylaxis progressing to front of neck access
– More straightforward intubations

Observing teams in action revealed what really mattered:

• Flow over completeness – layout shaped behaviour
• Team use over individual use – the checklist became a shared coordination tool
• Built-in pauses – created alignment before critical steps

Simulation as a Design Tool

This wasn’t simulation for training—it was translational simulation for iteration of a critical tool.

VEMS made it possible to:
– Rapidly test new ideas
– Observe real team behaviour
– Refine the tool in context

It also surfaced a crucial question from the team:

👉 How do we actually want this to be used in the department?

Final Thought

Cognitive aids don’t often fail because of poor content. They fail when they don’t match how teams actually work or support what they actually need.

By using VEMS, this team didn’t just update a checklist—they created a tool that fits the pace, structure, and reality of emergency airway management.

If you are interested in using VEMS as a simple tool to support your serious team check out SimSimple Kits available in our store.