“Enhancing Perioperative Emergency Readiness Through Simulation, ICS, and After-Action Review”—a poster by Rebecca Rayburn, RN, MS, CAPA, ABLS, perianesthesia senior nurse manager pre/post, and Meghan Rider, MS, RN, instructor of clinical nursing, both with University of Rochester Medicine’s Sawgrass Surgery Center—won second prize in the Periop Leader Week 2026 Poster Awards.
Their poster—which you can view in full as a PDF here—delves into the crucial role that simulation training plays in reinforcing safe practices during high-risk situations such as active shooters, severe weather events, power outages and much more. As the poster mentions, well-designed emergency drills strengthen psychological readiness, build real-world decision-making skills, improve interdepartmental coordination, test emergency plans and infrastructure, and support continuous improvement.
While staff knowledge of response protocols is great, a memorable simulation training drill allows them to apply what they’ve learned in high-pressure situations to strengthen their readiness for emergency response. Just as importantly, the drills provide leaders with the ability to identify knowledge gaps, as well as potential flaws in the emergency response system.
Ms. Rayburn and Ms. Rider do so through their After Action Review process, which they conduct with a multidisciplinary team after every drill or real-life event. Together, they evaluate performance and outcomes, identify gaps and opportunities for improvement, develop corrective actions with assigned ownership and follow-up, and incorporate lessons learned into policies, education, and future exercises. It’s a continuous cycle of evaluation and refinement.
We recently spoke with Ms. Rayburn and Ms. Rider about their award-winning poster.
Is the emergency drill system you’ve built in place just for Sawgrass Surgery Center, or systemwide for University of Rochester Medicine?
Ms. Rider: They’re using the periop environment as the trial, so they haven’t unrolled it to all the subsequent units at the hospital. It’s not fully systemwide yet, but that’s the goal.
Our poster judges liked that your robust process for drilling, including involving the community fire department and the police, different sorts of infrastructure failures or fire or weather emergencies, active shooter—all incident types that are low incidence but high criticality—and that you acquired a lot of data about the staff's confidence in managing situations after they had gone through each simulation. They said they hadn’t seen other organizations doing simulation to the extent you are, where you have a regular cadence of large-scale live simulations.
Rebecca Rayburn, RN, MS, CAPA, ABLS, Perianesthesia Senior Nurse Manager Pre/Post, University of Rochester Medicine Sawgrass Surgery Center
Ms. Rayburn: I think we do a really great job. Meghan’s done a lot with gaining pre-knowledge on where staff stands and how comfortable they feel. And our post-drill surveys really show great confidence among the staff.
Ms. Rider: For some drills we’ve done, like downtime documentation, many staff are newer to nursing and don’t really know how to do paper charting and documentation. Some didn’t even know where the paper charts were if they needed to access them. After the drill, a lot of the survey results were like, “I feel a lot more confident. I know where the stuff is. I may not be proficient at it, but I feel more comfortable utilizing it.”
Anytime you’re in an emergent situation, it’s already stressful. When you feel like you don’t know what you need to know, that makes it even more stressful. Bridging that gap of knowledge has really made a big impact for staff.
How are your emergency drills and simulations different from how you’d done them in the past?
Ms. Rayburn: We really didn’t have much of them before. We did general staff meeting education, but nothing to this next level where we’re thinking outside the box. We’re getting everyone involved from pharmacy, facilities, anesthesia, the business staff, the OR. Bringing all the areas together to work on these is super important.
One example we’re working on right now is an Amber Alert drill for when a child goes missing. About 50% of our patients are pediatrics, and we’ve never done a drill like this before. Our surgery center is on the first floor, and we have two clinics upstairs that don’t see a lot of pediatric patients. But we all have exits that we need to monitor. So we’re partnering with them and engaging them because at the end of the day, they’re going to need to help us watch those doors and be a set of eyes. The collaboration with other departments and staff has been really great.
Tell us about the types of drills you’ve done, and how often you do them.
Ms. Rider: We do our drills quarterly, sometimes more frequently. If we’re doing a tabletop drill, we touch on communication a lot; because we use walkie talkies as a main source of communication technique if we were ever without power, we do that one a little more frequently in addition to our regular drills.
So far we’ve done downtime documentation, active shooter, multiple fire evacuations, power outage with and without a generator backup. In the future, we’re planning on doing a weather simulation drill because in Western New York we have some pretty wild weather. Mass casualty is also on the docket. Down the line we also want to do suspicious package, or a bomb threat—something that is plausible probably not on a daily basis, but that could happen.
How do you design and build your drills?
Ms. Rider: Becky and I both have our masters in nursing education, so we utilize a lot of the skills we have in planning. Anytime I’m personally designing something, I do it almost backwards. I look at what my ultimate goal is, plan backwards from there and figure out what gaps in knowledge there are. I send out a pre-learning survey so I can see where people are feeling comfortable and maybe I don’t need to worry about that education as much, or where we need to dive deeper into some other parts of it.
We take a multidisciplinary approach. We have multiple planning meetings before the actual drill where we all come together—sterile processing, OR, the administrative staff, anesthesia, pharmacy. We always send out a group email summary afterwards, leaving people with, “This is your responsibility to bring back to the next meeting before we do the ultimate rollout of this drill.”
How long does that process usually take before rollout?
Ms. Rider: It’s usually a couple months.
Take us through the execution of these drills. When do they happen? How many people are usually involved in the simulation? How much time does it take? And how do you fit it into the overall schedule?
Ms. Rayburn: Every Thursday, our ORs start late, so we always have education time. We have a meeting at 6:00, which is pretty much all of the pre-op nurses. 7:00 is the operating room, and anesthesia will usually attend that one. 8:00 is our post-op, and that’s when all the other groups tend to come, whether it’s pharmacy or the business staff. So for any given drill, we’re doing it three times with different participants. We try to have the same objectives, but we do the drill a little bit differently depending on which meeting it is.
In the afternoon on that same day, after we’ve had our drills, we talk with our teams and get their feedback. Then we have our After Action Report meeting, where we go through the timeline and events—How did we drill it? What did we do? Was it a tabletop? Was it a hands-on drill? We talk about the feedback, and go through strengths, weaknesses, and any areas for improvement. We really lay it out—What was the issue? Who’s responsible? How can we fix it? And then a timeline of completions. We continually go back to those After Action Reports to see where we are and kind of follow it along.
What’s an example of a change you made or a corrective action that resulted from feedback you received from the simulations?
Ms. Rayburn: One that was really great was our mass evacuation simulation drill. We had the fire and the police and the ambulance and the entire building participated. One of the things we realized was when we say “go to the loading dock” or “go to the discharge door,” people who don’t work here don’t know what that is. So we got giant numbers, and we had all of our doors numbered, so we could say “go to Door 2” and they could easily find Door 2. That was one small thing, but can be a huge win when you need help.
Meghan Rider, MS, RN, Instructor of Clinical Nursing, University of Rochester Medicine Sawgrass Surgery Center
Ms. Rider: My favorite was when we did active assailant/active shooter. We did a walkthrough tabletop; it wasn’t a full all-hands-on-deck where you call the police and all that. It was more of an environmental awareness thing—If you’re walking through your environment, what could you use to run, hide, fight? Where could you hide?
After the drill, we realized we needed an easy, non-obscure way that people could see, “Okay, this room is lockable, I could hide in here and lock it, and you can’t get in unless you have the key.” So we put little stickers on the outside of the doors; if you saw it, you’d think it’s a benign sticker that doesn’t really have any meaning. But to us, we know it means you can get in there, lock it, and be safe. That was a really good takeaway from doing this walkthrough, because some people said, “I don’t really know where I could hide and lock a door.”
Ms. Rayburn: Another great example was our drill for no electricity and no generator. We realized that none of our Philips monitors, when we purchased them, had batteries in them, so they were completely dead to us. The only thing that worked were the 10 operating anesthesia machines. That was a great lesson learned. If there were an emergency, we got nothing.
So Meghan made some great grab-and-go kits that have little portable pulse ox so you can at least monitor the patient’s oxygen saturation, and manual blood pressure cuffs. It was a cheaper fix because not only would we need to purchase the batteries for 53 monitors, but they’re only good for so long, so is the cost worth it?
Your poster mentions an Incident Command System (ICS)—a standardized management hierarchy and procedures for managing incidents of any size. Describe that concept and how it applies in your system.
Ms. Rayburn: We have our ICS at the same location all of the time—the front of our building. We like to standardize all of our drills and always utilize that location for incident command. We all grab our walkies and go to that central location. There’s one point person, usually the most senior leadership person on site at the moment, who will coordinate any operational issue or whatever the scenario is. There are point people for executing—“I need this, I need this, that person’s on it.” Another will plan and track resources. Another will order logistical materials depending on the drill. Another monitors the costs and how much is being spent.
Meghan, you mentioned games. What sorts of games are involved?
Ms. Rider: I made an escape room for the staff about a power outage. We already did a big drill on it, so it was important to me to make a more interactive simulation instead of having the same thing regurgitated to them. I had six different stations, and they had to open one box to get to the next box. All the games I made were related to power outage—like “Categorize which things are going to work on battery backup and which are not.” It was more of a recall of knowledge and an application versus just the same thing we did the last time.
For the active assailant drill, I put everybody in a different area of the building—some that we’re always in, some that we’re not in all the time—and had them jot down what you could use as a weapon. Then I had them all come back together and said, “All right, which doors were lockable in your area? What could you use as a weapon in that general area? Where is the nearest panic button to you if you’re not in the area you’re always in?” Just making it a little more interactive and fun.
How do you make sure that what people learn during these drills sticks?
Ms. Rider: I think it’s doing it quarterly. I’m just a regular staff nurse; I’m not in leadership here. So I’m always amazed when people come by and chat with me afterwards—"Okay, so where was that exit again? I know you said it was over here, but I don’t know where that is.” And I say, “Well, let’s bunny up, let’s go back there, and I’ll show you.” People are so actively engaged. Not a lot of places have the dynamic that we do, where people are actually super invested in knowing their environment, and are truly active participants. They are in it to win it. So a lot of it is them too.
What feedback have you received from senior leadership about what you're doing with the drills?
Ms. Rayburn: At the end of the quarter, we meet with all of senior leadership within periop. Then we take these to our regional meetings, and they are just astounded. They are so engaged and so thankful we’re doing this. I’m very proud that in 2022 it was suggested to the director that this is an area we’re lacking in, and that we’ve come such a far way.
What advice would you give to peers who would want to replicate what you’ve done, or want to improve their emergency preparedness drills?
Ms. Rayburn: That's a great question because we actually had somebody reach out to us who had seen our poster at Periop Leader Week and we were like, “Oh, we need to get together. Don’t recreate the wheel. Let us help you.”
Ms. Rider: Survey staff’s knowledge before and after, and ask the right questions. You want to know what they already know about this, so you can help them with those gaps, and you want some sort of proof that they actually learned something. Doing a survey before and after is super important.
Do you cover those things that are already known, or you just assume everybody knows them and focus on the unknown stuff?
Ms. Rider: I make no assumptions. I treat everybody like it’s their first day here, with the caveat that “I know we’ve gone through this, but we do have new staff, and they need to know it. Nobody knows everything about everything, so we just need to quickly review it.”
Were there any incidents that actually occurred where you saw that the work you’ve put into these simulations paid off?
Ms. Rayburn: When real things happen, it highlights some other things we need to put into our drills. We had a water leak and it highlighted how sometimes when things come up that you really need somebody to say, “Okay, we got it, go away,” because people just want to come check it out and see what’s going on. Yes, everybody wants to know and everybody wants to help, but too many people really just need to go away. That always sticks in the back of my mind—sometimes too much of a crowd is not helpful.
We had another scenario where there was a humidity/temperature issue in the OR, and it was out of range for a little too long. So we had to stop doing the surgery and figure out a plan for those patients. In the past, we’d congregate in an open area, and we realized that didn’t work well. So the next time this incident happened, we went into our education room, which is further away, but we realized that was too far away, and the communication needed to be better between the people in the room and the charge people outside. Every issue that comes about, we are learning and continuing to grow with things that don’t really happen with a drill because the issue never came up. We’re always learning.
Ms. Rider: Especially when we’ve done fire evacuation, something that we wouldn’t have known had we not done the drill is we don’t always know where staff is—if they're here that day, if they’re not here—so now we have a staff accountability sheet where people have to sign in and sign out, which sounds pretty standard, but it wasn’t. So we do that now. When you come in for your shift, you sign in. If you’re leaving for lunch or for the day, you sign out. That way, charge can get that sheet and say, “Yes, these staff members left so we don’t need to send a firefighter in there to look for them and put their life on the line for no reason.”
We have key cards to tap in and out everywhere, but in an emergency, they’re not going to log into a computer to track anything. We needed a quick grab-and-go method because when we meet at the rally point outside for a fire drill, it’s a quick grab-and-go way for us to say, “Yep, this person’s accounted for; they’re right there." Or, “Yep, this person left. I know for a fact they signed out.” It was a big win for us, and a really easy implementation.
When you made this poster, what were the most important things you wanted to convey to your peers about what you’ve accomplished?
Ms. Rider: What I wanted to convey was the staff has gained so much knowledge and confidence in applying what they’ve learned, and that we’re actually doing the hard work it takes to plan it. A lot of planning goes into these drills that you don’t really see when you’re participating in them. You just see a fun game or whatever it is, but you don’t see all the meetings leading up to it.
We’re really trying to convey all of the learned information, but also how much we’ve applied that information. We’re not gathering information just to gather it. We’re actually applying it to something that’s going to make a difference for all of us.
Ms. Rayburn: I really think we’ve done a great job, and that staff feels very, very supported. I really love what we’ve done with this, and I’m super proud of it, and would love to share it with other people. That’s why we wanted to do the poster—to highlight all the great things we’ve done.
Anything else we didn't cover that you'd like people to know?
Ms. Rayburn: We’ve just been persistent and have continuous follow-through. Because of the drills, we got panic buttons. We got a lockout button. We got cameras. We assessed the lighting in the parking lot. We've done so much.
Want to learn more about how these talented perioperative nurse leaders teamed up to take their emergency drilling program to new heights? Connect with Ms. Rayburn via email or on LinkedIn. Connect with Ms. Rider via email or on LinkedIn.
