Transcript Planning and Implementation of simulation Laboratory Design

Planning and Implementation
of a Simulation Laboratory
Design
Roberta Wattleworth, D.O., MHA, MPH, FACOFP
Professor and Chair, Department of Family Medicine
Director, Simulation Laboratory
The Question
 Why Build a Simulation Lab?
 Increase preparedness of second-year
students before they go out on rotation
 Introduce physiology/
pharmacology/microbiology, etc. into
medical cases for first-year students
 Complement cases 3rd and 4th year
students receive on rotation
 Increase positive outcomes for highstakes crises
 Entice well-qualified undergraduate
students to enter our program
 Demonstrate the value of team-building
and collaboration as we incorporate
EMS, pharmacy students, nursing
students, etc. into our scenarios with the
medical students
Location
 Preferably ground level with elevator
access
 Tank switch-out
 Easy access for complex scenarios (ER, OR,
etc.)
 Consider “garage door” on one side to
simulate an ER ambulance bay
 Depending on which gases are used in the
lab, the tanks have to be protected from
vandalism, theft, risk of explosion, etc.
Simulation Room Design
 Give yourself room to maneuver
 At times more than one scenario can
take place (mother delivering baby
becomes unresponsive from blood
loss while infant is being resuscitated)
 Consider a retractable divider that
can be used to make the room
resemble a large trauma room or a
small individual ER room
 Appropriate ventilation
 Scavenger system if anesthesia is used
 Rooms heat up quickly between
equipment and fear!
 Ceiling height is critical if you will be
installing surgical lights
 Flooring – “fake” blood loss can be
copious at times (post-partum
hemorrhage, vascular trauma) –
linoleum can become slippery and
pose a hazard; carpeting will become
quickly soiled
 Rooms should have one-way viewing
glass on two sides to allow control room
and observation room a clear view
 Cameras should be directed from several
angles for maximum viewing
 Microphones should be in close proximity
yet not be in the way
 Include computer terminal to pull up lab,
x-ray reports.
Debriefing Room Design
 Large viewing windows into simulation room
 Large table with computer ports and comfortable
chairs
 Base the size of the room/table on the number
of participants per group – six students is the
recommended maximum
 Smart board to view video of just-completed
scenario, an example of the same scenario run
differently, or for discussion of post-encounter
questions
 Dry erase board
 Duplicate patient monitor with tracings
identical to tracings in simulation room
 Video taping capability of debriefing
sessions
 Storage rooms – often overlooked. Must
be large enough to allow you to buy in bulk
and store
Funding
 Existing sources
 Grants
 Collaborators
 Do they bring funds or expertise to the mix?
 Often want to see copies of policy and
procedure documents, job descriptions of key
employees, etc.
Financial Analysis
 Plan an initial budget for five years
 Expect to lose money for the first three
years
 Outline start-up costs as well as ongoing
operating expenses
 Be sure to include depreciation of
simulators!
 Ideally stagger large purchases so
replacement costs don’t hit you at once
 Include a large travel allotment initially to
allow for visits to existing simulation
centers
 Training program for key faculty is a must!
Metrics to collect
 Occupation rate (by room or by hour)
 Number and type of learners (students,
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residents, nursing, EMTs, attending physicians)
Net loss/income
Faculty time allocated to time in labs vs. case
development
Number of scenarios that have been developed
Satisfaction from learners – increased
confidence, competence
Document how competencies are tied into
scenarios for accreditation
Developing Performance
Standards
 Must be developed for each scenario to allow for
more consistent scoring
 “Weight” of standard may be higher as to the
time to critical decision-making or failure to act –
reflects patient safety issue
Example
 Information below is presenting information
provided to participant prior to entering the room
Previously healthy 8 year-old male arrives in the ER
department approximately 30 minutes after being
struck by a car while riding his bike. He was wearing
a helmet; EMTs report witnesses did not note loss of
consciousness prior to arrival of ambulance. The
child complains of left leg and left rib pain
Vitals: H 140 R 24 BP 78/58 T 99o F O2 sat 98%
Ht 130 cm wt 30 kg
Scoring
5 pts_____ Brief confirmation of history from
patient
20 pts____ Conducts primary survey within
60 seconds (airway, breathing,
circulation, disabilities, exposure). One
point deducted for every 10-second
interval past 60 seconds until survey is
started)
10 pts____ Order given to administer fluids as
bolus
5 pts_____ Successful starting of IV with minimum
size of 18 g needle
10 pts _____ Request to type and cross blood should be
made within two minutes after completing
primary survey. One point deducted per minute
of delay.
10 pts_____ Secondary survey – failure to note increased
heart rate, decreased blood pressure and
distended abdomen will trigger code due to
hypovolemia
10 pts_____ Surgical Consult must be done – one point
lost per minute delay after secondary survey
completed
10 pts_____ Team Leadership if in group setting
Total case value 80 points
Earned score
____points
Debriefing
 Takes longer for medical students than residents
since more in-depth discussion of anatomy and
physiology should take place
 Have participants use laptops to investigate
answers to questions posed after the scenario
yet before debriefing.
 What is the most likely source of blood loss in this
patient?
 Why are children more prone to injury in this area?
 Discuss the physiology behind the elevation of heart
rate while blood pressure was dropping.
 What volume of blood does this child have circulating
and how much can he lose before critical loss is
reached?
 What long-term consequences will this patient likely
experience as a result of the proposed surgery?
 Once answers have been typed in along with
their reference source, they are printed off for
scoring and will become part of the participant’s
permanent chart
 Discussion of the case, scenarios, and possible
review of the videotape now takes place along
with discussion of the post-encounter
questionnaire
Evolution of our Lab
 Initial discussion for creation of the
simulation lab took place February ‘06
 Appointment of director of the sim lab,
chair of the simulation committee, and
committee members
 Meetings took place with members of
various colleges to confirm where
simulation exercises could be incorporated
into their curricula
 Decisions were made as to faculty
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Full time lab coordinator
Full time clinical coordinator
Part-time director (.4 FTE)
Part-time secretarial support
 Job descriptions were created
 Search committee interviewed candidates
for both positions – lab coordinator started
February 1, 2007 and clinical coordinator
started March 1, 2007.
 Site visits to existing simulation labs
 Attendance at training programs
 International Meeting on Simulation in
Healthcare January 07
 METI training program Feb. 07 and Mar 07
 Harvard Institute for Medical Simulation
Comprehensive Workshop May 07
Simulators
 METI HPS
 METI child
 Laerdal adult
 Laerdal baby
 Gaumard birthing simulator (Noelle)
METI HPS
METI child
Laerdal adult
Laerdal baby
Gaumard birthing simulator
(Noelle)
Future Plans
 Formation of the Center for Clinical Skills
Development
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Harvey Heart Sounds Simulator
Standardized Patient Assessment Laboratory
Surgical Skills Lab
Simulation Lab
 For the first two years we will concentrate
on incorporating simulation into the first
two years of curricula
 As our third year students are brought in
closer to Des Moines for core rotations,
they will be brought back for scenarios in a
format resembling their COMLEX-PE
experience. Those students felt to be at
risk for failure will be given intensive
instruction and remediation
 We eventually want to “sell” time to area
hospitals for resident training, area nursing
and paramedic schools, and Drake
College of Pharmacy
 Using analysis of data, we hope to
convince outside funders of our goal to
improve patient safety, and apply for
grants to help with ongoing expenses.