October 7, 2019By Dr. Kim Baily

OR 360: Simulated OR of the Future from Cedars-Sinai & DoD

In 2014, Cedars-Sinai partnered with the U.S. military to design the “operating room of the future” with the goal of improving outcomes during the first “golden hour” of trauma patient care. Today Dr. Kim Baily PhD, MSN, RN, CNE, previous Simulation Coordinator for Los Angeles Harbor College and Director of Nursing for El Camino College, takes a closer look at this unique training space, named “OR 360”, which was funded by $3.8 million in grants from the US Department of Defense. Since opening, research topics studied in the OR 360 have included human factors, safety, efficiency and errors in trauma care as well as technological and teamwork integration and handoffs/handovers.

According to Bruce L. Gewertz, M.D. surgeon-in-chief and chair of the Department of Surgery at Cedars-Sinai, the goal of the project was to “ improve the efficiency and effectiveness of acute trauma care in both civilian and military settings by introducing innovations in communication, technology, workflows and the way medical personnel perform their jobs. The quicker we get patients cared for, the better the outcomes.”

The 23,000 ft space includes, meeting rooms, offices, study areas, control room and operating room/simulation lab. Cannon Design and Level 3 Healthcare both played a role in the development of the space. The OR ceiling equipment such as IVs, lights, and monitors is moveable with equipment attached to a custom-made ceiling trolley system on tracks that allows pieces to pivot around surgical teams. The suite walls are both moveable and demountable thus the space can be configured in a variety of ways.

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OR 360 is part of the Cedar-Sinai’s Women’s Guild Simulation Center for Advanced Clinical Skills. When changes to clinical practice are suggested, the proposed new process can be thoroughly researched in the OR 360 where the ideas can be developed and tested without any risk of causing patient harm. The next step is to conduct full scale simulations in the Women’s Guild Simulation Center for Advanced Clinical Skills. This stage may involve high-fidelity simulation. Finally, new interventions are introduced to actual clinical practice. Some of the research projects conducted in the OR 360 include:

  • Understanding Flow Disruptions in Robotic – Assisted Surgery.
  • Observation of Process, Teamwork and Error in Surgery: A Measurement Framework.
  • Achieving Flow in the Trauma Process Using Human Factors Methodology.

Research in Human Factors in OR 360 have led to several new design interventions already being implemented at Cedars-Sinai including color-coded trauma bays, whiteboards to display key patient information, and space for pre-briefings. All of these interventions led to more efficient care of trauma patients.

Currently, the OR 360 is set up in an escape room format which is being used for human factors research related to team performance in healthcare. The project is led by Dr Tara Cohen (Research Scientist/Assistant Professor, Dept. Surgery) and Dr. Gewertz. Team composition, communication, leadership and emotional intelligence are being investigated by using an interactive puzzle-solving experience in the form of an escape room. The escape room creates an immersive laboratory environment which is currently available to teams of three to eight clinical staff. The teams are challenged to work together to solve a specific problem within a relatively short space of time. Prior to the experience, the team receives a short presentation about how to work in teams to solve problems. Following the challenge, the teams discuss what went well and what behaviors they might consider changing in the future.

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With OR 360, Cedars Sinai with support of the DOD, has created a wonderful healthcare simulation laboratory that fosters creative approaches to medical care and interdisciplinary communication that are only limited by the power of the human imagination. Learn more about OR 360 here!

More About the Cedars Sinai Women’s Guild Simulation Center

The Women’s Guild Simulation Center for Advanced Clinical Skills, directed by Russell D. Metcalfe-Smith FHEA, MSc, NRP, CHSE-A, CHSOS, is an immersive environment equipped with the latest in patient simulators and medical devices. The center replicates the reality of professionals working together, performing different roles and using the latest technology within our system. Multi-professional clinical skills development, teamwork, improving communication and, ultimately, patient safety are at the heart of the center’s ethos. This proactive approach helps Cedars-Sinai provide the best possible care to patients and provides staff with the latest in educational technology. The center is accredited and endorsed by several leading healthcare organizations including the Society for Simulation in Healthcare, the American College of Surgeons and the American Society of Anesthesiologists.

The 10,000-square-foot Women’s Guild Simulation Center comprises two fully equipped and functioning operating rooms, an ICU, OB/GYN room and a trauma bay. It has a PICU/NICU and multiple rooms for skills training and development. The center also includes a fully equipped computerized simulation room with human patient simulators for practicing almost every procedure, as well as robotic surgery. In the video below, take a look inside to see what makes this a transformational training facility. The Women’s Guild Simulation Center is home to 13 robotic medical manikins that can blink, bleed, talk, hyperventilate and give birth, as well as one anatomical patient simulator that looks and feels completely real and allows for practicing surgical techniques.

The Women’s Guild Simulation Center offers a broad range of existing services and courses to challenge a variety of disciplines, and can customize training to meet specific needs including a course on the Maintenance of Certification in Anesthesiology (MOCA) Simulation Training and Acute Life Threatening Events Recognition and Treatment (ALERT) Training.

Learn More About the Women’s Guild Simulation Center Here!

Today’s article was guest authored by Kim Baily PhD, MSN, RN, CNE, previous Simulation Coordinator for Los Angeles Harbor College and Director of Nursing for El Camino College. Over the past 16 years Kim has developed and implemented several college simulation programs and previously chaired the Southern California Simulation Collaborative.

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