The integration of simulation in health professions education has forever altered what was once a very traditional, apprentice-like trajectory to acquiring professional status. Across educational settings simulation has become a common and accepted teaching methodology. Simulation however is not limited to undergraduate education or psychomotor skill training. Simulation-based educational activities are being more commonly embedded in a variety of in-hospital activities. When we earn our designations as healthcare professionals, we commit ourselves to being life-long learners. Hospital based simulation programs can meet these life-long learning needs by providing periodic skill refreshers or the opportunity to review low-frequency-high-acuity events. Simulation however can also be pivotal in safety and quality improvement initiatives. Simulation has been adopted by many healthcare organizations for everything from team and communication training, to studying new processes to recreating adverse events in order to learn.
Business and consumer sectors of every description are more cognizant to client and customer experience than ever before. Client/customer experience is a key indicator of success. Healthcare systems and institutions are similarly charged with providing a high quality experience and providing meaningful and personal care to each and every patient. Hospitals need to go beyond simply providing “hot coffee and correct change.” Patients’ perceptions of their experience are captured in the “Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. These surveys in turn determine Medicare reimbursement. Indeed, it is fiscally prudent to want to see increasing HCAHPS scores, however as healthcare providers, we prioritize safe, effective and holistic patient care. A hospital can provide life-saving treatment, make correct diagnoses and employ the latest technology to solve patient problems, but if a patient does not perceive an adequate level of communication, care and cleanliness of the hospital environment, this will be reflected in the HCAHPS. The skills needed to create a positive provider-patient interface are not necessarily natural or intuitive to people.
"Hospitals across the country have integrated simulation in to training and education programs around patient experience and slowly, the healthcare literature is reflecting this trend"
As well, healthcare professionals are adult learners in that they like their education to be relevant, practical and immediately applicable to their situation. Hospitals across the country have integrated simulation in to training and education programs around patient experience and slowly, the healthcare literature is reflecting this trend. It is now very common for a hospital, whether it is community based or a large academic health center to have dedicated simulation staff to coordinate and implement programs. At the core of any simulation initiative whether it involves trauma skills or communicating with families is the ultimate goal of patient safety. Simulation is a natural fit for so many types of initiatives as they allow staff to enhance patient experience and ultimately provide safer care.
At Medical City Dallas Hospital, we use high fidelity simulation (HFS) as a part of a blended learning curriculum. The clinical education team collaborates with subject matter experts to develop an assessment of needs and identify the learning objectives for each clinical area. A combination of pre-developed programming and self-authored scenarios is used. Using HFS in this way has allowed us to meet department specific needs within the facility, in the simulation center and in situ in the departments. Our simulation programs cover the entire lifespan from maternal /OB scenarios for delivery, shoulder dystocia, and post-partum hemorrhage to end of life. We provide our nursing interns with a variety of experiences from emergency response to more specific scenarios such as stroke via HFS. This enables the employee to experience scenarios and refine skills with realistic patient interactions prior to working. Simulation for new hires includes low fidelity simulation via task trainers as well as HFS for reinforcing elements of our patient experience program. Other programs that utilize simulation include: trauma nurse certification courses, emergency nurse certification, Neonatal Resuscitation Program and American Heart Association Programs. Our pediatric nurse liaison facilitates pediatric simulation in emergency departments within the HCA North Texas division. The pediatric transport team uses simulation in community outreach, and to EMS providers and physicians. Utilizing simulation to test our system processes and workflows is an integral part of providing world class care at HCA.
In addition to using simulation extensively for training and education at Children’s Mercy, the Center for Pediatric Simulation also utilizes it for testing the organization’s emergency response systems. The capabilities for emergency response vary across the health system, largely depending on location and staffing. The Simulation Team tests this capability in various locations by designing and implementing “drop-in” mock codes. These high fidelity in-situ simulations are written with objectives that focus on systems testing rather than learner education or training. Usually, the simulation involves a mannequin, but sometimes one or more standardized patients are needed. The Simulation Team conducts these scenarios in inpatient areas of 2 hospitals (Inpatient Code Blue response), outpatient and public areas of both hospitals (Emergency Ambulatory Response System (EARS) response), MRI at 3 locations (MRI Code Blue response), and outpatient clinic buildings both near the main campus and at outreach locations in 2 different states (Free Standing Clinic Code Blue response). To adequately test the emergency response system, the simulation is not announced to the staff until the scenario actually begins. The simulation continues until the participants fulfill the scenario objectives. After the scenario, a facilitator conducts a short debriefing that focuses on system level issues. While the objectives are directed towards detecting system issues, the participants do often learn pearls that will help them take care of actual patients in crisis. The facilitator submits a report to stakeholders detailing the points discussed during the debriefing (while maintaining participant confidentiality). Simulation staff also have the option to enter issues into the organization’s event reporting system to escalate those problems that might be considered higher risk.