Try Simulation Training to Improve Teamwork, Collaboration, and Patient Safety

When people in healthcare hear the word simulation, they generally think of a computerized mannequin that talks, breathes, and has other human physiological characteristics. Though the development of this human patient simulator, or HPS, has been able to serve as a breakthrough in the teaching/learning environment, there is more than meets the eye with the whole field of simulation.

Human patient simulation
HPS technology has been in use for about the last 10 years in some fashion. Implementation of HPS technology originally gained the most attention in nursing and medical schools, where its use continues to proliferate as new users encounter this technology for the first time.

More recently, such technology has made its way to the clinical practice arena and is used for orientation of new graduate nurses, ongoing staff development, staff competency assessments, required courses such as ACLS and PALS, and team training exercises for interprofessional education.

HPS technology is considered high fidelity, meaning that it is more lifelike than the older mannequins that did not respond via voice or change in physiological parameters when an intervention occurs. For example, high fidelity HPS technology can make a palpable pulse go away when there is ventricular fibrillation or asystole on the cardiac monitor, raise and lower the blood pressure in response to a drug being given, etc.

Standardized patients
There are other simulation teaching/learning modalities that can be used in concert with HPS technology or by themselves. Standardized patients, or trained medical actors, have been used in medical schools for the past 40 years to help medical students interact with real human beings. The use of SPs, as they are referred to, is gradually started to grow in nursing schools. SPs can act not only as a patient but as a family member or a disruptive colleague. This is particularly important, say, when staff development educators are trying to teach clinicians about teamwork and how to assertively speak up if they see something wrong.

For example, a "confederate," (also referred to as a disrupter), SP can act as an overbearing physician who adamantly insists that a nurse give a drug, even though it is not appropriate in that particular clinical situation and giving that drug could cause extreme harm or death to the patient. During the simulation activity, the nurse can learn how to effectively confront this confederate with good communication skills, which are an essential part of teamwork and patient safety.

Serious games and computer interactive devices
Other simulation modalities include serious games, which are essentially video games that are designed to teach concepts in an immersive computerized environment. The same game development technology that is used to build entertainment-focused virtual game worlds where "players" interact online using avatars (onscreen representatives of themselves), can be used to build learning games. Since the average age of video game players is now almost 40 years old, many in the workforce are very comfortable with this technology and would naturally be adept at learning this way.

Medical and surgical simulators, including devices that teach bronchoscopies, endoscopies, surgical procedures, coronary angiography, and many other skills, are proliferating in use. Computer interactive devices that teach IV insertion and IV therapy skills can be used for many different levels of providers, including paramedics, nurses, physicians, physician assistants, etc. Investment in these simulator devices, particularly for high-risk skills, can truly pay off in the long run.

Teaching teamwork
With patient safety being paramount, many institutions are using simulation modalities to teach and enhance interprofessional team training. One model that is commonly used is the Agency for Healthcare Research and Quality and the Department of Defense's TeamSTEPPS system, which stands for Team Strategies and Tools to Enhance Performance and Patient Safety. Since healthcare teams are often contingency teams where the individuals do not necessarily work together on a regular basis (unlike a football team), there is even more need to make sure that all staff are trained in good teamwork and communication skills as they are not likely to know each other's capabilities and weaknesses.

Using simulation techniques can provide a safe and effective environment for all levels of staff to learn and interact with others on the healthcare team. More information on TeamSTEPPS can be found at http://teamstepps.ahrq.gov.

Competitive advantage of simulation
One of the major challenges that permeates simulation methodologies is cost. HPS can run tens of thousands of dollars for the initial investment alone. SPs are generally paid hourly not only for their simulation time, but for their rehearsal and training time for each character that they portray.

Serious games can be expensive for an initial startup, but once built, that technological platform can be used to produce different immersive learning scenarios very efficiently and effectively. Medical and surgical simulators, though costly, can be used extensively and with many learners over a long period of time. Even with the cost issue, these methodologies are extremely important to implement if institutions wish to remain competitive.

For example, students who are graduating from nursing and medical school have now been generally exposed to some type of simulation teaching/learning during their educational program. They naturally expect the institutions at which they will work will also have the same technology and employ the same teaching/learning strategies. Having a solid simulation program at an institution where the equipment and infrastructure are in place, along with well-trained and enthusiastic staff development personnel, can only be a plus for recruitment and retention of staff. In addition, simulation has been shown to increase learner retention and engagement. As noted previously, it provides a safe alternative to learning and practicing difficult skills since no real patients are involved.

One way to control costs is to partner with the healthcare professional schools in the local region. Regional simulation centers are growing around the country, and sharing of resources can help control costs for all involved. In addition, it can have the added benefit of bringing together diverse learners who might not otherwise interact. Multi-environment simulations can also be done in these centers, such as an EMS transport to the emergency department, then a transfer to the ICU, and then a transfer to the operating room.

The technology for simulation modalities is continually improving as companies respond to user requests for more and more capability. Institutions need to jump on the bandwagon or will eventually get left behind as this progression occurs.

For more information on the many uses of simulation, go to the Society for Simulation in Healthcare Web site at www.ssih.org.