1 Simulation: A paradigm shift in healthcare education and practiceCrystal Graham, PhD, RN, CHSE Interprofessional Simulation Director Francis Marion University
2 Disclosure Statement Dr. Crystal Graham has no financial or commercial interest in this content
3 Objectives Describe the types of simulation available for use in clinical practice. Demonstrate how teams of healthcare professionals can integrate simulation into training. Participant will be able to compare this opportunity to current needs in their organization and construct a similar opportunity to meet their specific challenges. Here are the specific objectives I would like to present and cover today during this opportunity.
4 Call From Above Preventable medical errors in hospitals exceedattributable deaths. average cost between $17 billion and $29 billion annually in hospitals fragmented nature of the system or “non-system” - multiple providers incongruent communication Institute of Medicine’s (IOM) 1999 report, To Err is Human: Building a Safer Health Care System. Patient safety efforts including designing safer health systems (5 year goal; 50% reduction) - IOM report results Simulation training is recommended as a strategy that can be used to prevent/decrease errors in the clinical setting. As a result of the IOM report, there has been a substantial increase in the number of patient safety publications and research awards. Focus shifted from malpractice to organizational culture (dispensing blame to improving systems)
5 Types of Medical ErrorsDiagnostic Error or delay in diagnosis Failure to employ indicated tests Use of outmoded tests or therapy Failure to act on results of monitoring or testing Other Failure of communication Equipment failure Other system failure Treatment Error in the performance of an operation, procedure, or test Error in administering the treatment Error in the dose or method of using a drug Avoidable delay in treatment or in responding to an abnormal test Inappropriate (not indicated) care Preventive Failure to provide prophylactic treatment Inadequate monitoring or follow-up of treatment
6 Communication Root cause of approximately 70 percent of sentinel events JCAHO National Patient Safety Goals 2007 Effective communication and teamwork enhance the quality of patient care. Focus shift from intra to inter
7 Safety It is well documented in many initiatives leading healthcare organizations driving improved patient outcomes (AACN), World Health Organization (WHO), QSEN, The Joint Commission, that the benefit of Interprofessionality will improve patient outcomes and decrease sentinel events. Interprofessional https://www.youtube.com/watch?v=oH6jQE7J4xM
8 What is Simulation? “A technique, not a technology, to replace or amplify real experiences with guided experiences, often immersive in nature, that evoke or replicate substantial aspects of the real world in a fully interactive fashion”(Gaba, 2004,p 2).
9 Changing mind set in education…how do people really learn?
10 Growing Issues Medical procedures are becoming more numerous and more complex –medical knowledge has hypertrophied. Clinical setting is not the place to “practice” skills.
11 A simple understanding of types of simulation
13 Task trainers
16 Virtual simulation stations
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19 Three Phases of DebriefingReactions - Clear the air and set the stage for discussion Feelings Facts Understanding Exploring - explore participant perspectives on scenario events Discussion and teaching Summary - distill lessons learned for future use What worked well What should be changed next time Major take always
20 Value Improve Psychological safety Controlled environmentCritical Thinking Judgment Organizational culture Prioritization * Communication * Psychological safety Controlled environment Repetitive practice, proficiency Enhanced teamwork and collaboration Cognitive, practical understanding
21 Research OpportunitiesImmersive Simulation for Design and Evaluation of an Emergency Department IT Principal Investigator: Ann Bisantz, PhD, State University of New York at Buffalo Improving Pediatric Resuscitation: A Simulation Program for the Community ED Principal Investigator: Linda L. Brown, MD, Rhode Island Hospital, Providence, RI Improved Patient Safety by Simulator-Based Training in Cardiac Surgery Principal Investigator: Richard H. Feins, MD, University of North Carolina at Chapel Hill
22 Improving Patient Safety Through Leadership and Team Performance in Simulations Principal Investigator: Rosemarie Fernandez, MD, University of Washington, Seattle, WA Acceleration to Expertise: Simulation as a Tool to Improve the Recognition of Sepsis Principal Investigator: Gary L. Geis, MD, Children's Hospital Medical Center, Cincinnati, OH Improving Physician and Nurse Communication with Serious Gaming Principal Investigator: Mary E. Mancini, PhD, University of Texas, Arlington
23 Patient Outcomes T1 – design and delivery of educational protocols and measurement of outcomes in controlled settings. Central Venous Catheter Insertion(Internal and Emergency Medicine) T2 – better patient care delivery practices ( ACLS, complicated obstetrical delivery) Residents with sim had fewer needle passes, catheter adjustments, arterial punctures, and with higher success T3 – further downstream to improve patient or public health outcomes (faster surgical recovery) directly linked to educational interventions (skillful laparascopic surgery) Observational study on catheter related bloodstream infections (32 months) 85% reduction in infections after residents with sim entered ICU
24 Is simulation profitable?
25 } Powerful Motivators Motive 1: Lower Cost Motive 2: Better Access toSymptoms/Cases Motive 3: Reduced Training Time Motive 4: Reduced Errors } Powerful Motivators Smith, R. (2009). Embracing game technology for medical education. Retrieved from
26 The reality is: "We should measure clinical ROI in terms ofmeasurable impact on patient care.” (Page, 2010) Page, D. (2010). IT’s return on investments is tricky to pin down. Hospital & Health Networks. Retrieved from /articledisplay.jsp?dcrpath=HHNMAG/Article/data/06JUN2010/1006HHN_Fea_MostWired&domain=HHNMAG
27 7-1 healthcare cost return on investmentCost savings 7-1 healthcare cost return on investment Approximately 9.95 CRBSIs were prevented among MICU patients with CVCs in the year after the intervention. The annual cost of the simulation-based education was approximately $112,000. Net annual savings were thus greater than $700,000, a 7 to 1 rate of return on the simulation training intervention. Simulation was the reason for substantial cost-savings, not system, cultural, process changes Direct Revenue
28 References Cohen, E.R., Feinglass, J., Barsuk, J.H., Barnard, C., O’Donnell, A., McGahie, W.C., Wayne, D.B. (2010). Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit. Simulation in Healthcare, 5(2), pp Gaba, D. (2004) The future vision of simulation in health care. Quality and Safety in Health Care, 13 (Suppl 1), Institute of Medicine (1999). To Err is Human: Building a safer health care system. Gaba, D.M., Howard, S.K., Fish, K.J., Smith, B.E., & Sowb, Y. (2001). Simulation-based training in anethesia crisis resource management (ACRM): A decade of experience. Simulation Gaming, 32, McGahie, W.C., Draycott, T.J., Dunn, W.F., Lopez, C.M., & Stefanidis, D. (2011). Evaluating the impact of simulation on translational outcomes. Simulation in Healthcare, 6, S42-S47. Page, D. (2010). IT’s return on investments is tricky to pin down. Hospital & Health Networks. Retrieved from Smith, R. (2009). Embracing game technology for medical education. Retrieved from 2009_RSmith_MT3.pdf.