January 23, 2020By Dr. Kim Baily

International Meeting for Simulation in Healthcare 2020 Final Session Wrap Ups

The International Meeting for Simulation in Healthcare (IMSH) from the Society for Simulation in Healthcare (SSH)wrapped up yesterday after five days of amazing medical simulation events, from expert presentations to innovative products — the show brought together over 4,000 clinical simulation champions from all over the world! Today, we share the final wrap up of session coverage from presentations taking place later in the schedule. From the leading communication model for healthcare professionals to targeting simulation based off needs assessments, scenario development blueprints and plenary recaps — check out these awesome session summarizations from Dr. Kim Baily!

TeamSTEPPS Communication Protocol to Maximize Patient Safety

TeamSTEPPS IMSH hands-on workshop. This session provided information about designing an interprofessional simulation using a TeamSTEPPS framework. Interprofessional simulation provides an opportunity for people with different training backgrounds to come together and work as a team to care for a patient by improving communication and collaboration within the team. Response to critical situations in healthcare often involves teams of healthcare professionals with varying levels of expertise but they must all work together to help patients. Ineffective or insufficient communication among team members is a significant contributing factor to adverse reactions.

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Since there was limited time for the class only selected components of the TeamSTEPPS system were included. The standardized framework for members of the healthcare team to communicate about a patient’s condition is the SBAR – situation, background, assessment, request/recommendation. Another component is the mutual support component the “CUS” statement: I am Concerned, I am unComfortable, this is a Safety issue. The third was a leadership component brief/huddle/ and debrief and the fourth component was the situation monitoring where one observes the actions of a fellow team member. The class was challenged to create objectives and case stem for an IPE simulation within the TeamStepps framework.

Targeted Simulation Needs Assessment

This healthcare simulation conference session entitled Targeted Simulation Needs Assessment provided a step-by-step guide to completing a targeted needs assessment of simulation from first-hand experience at a large multihospital health system. The first step begins with identification of three levels of stakeholders. The first group are the key stakeholders, the number of which will vary depending on the size of the institution. Typically the key stakeholders might be the existing users of the sim lab. The secondary stakeholders are groups that use the simulation lab less often and those that should be using the lab but do not.

The last group of stakeholders are those in key leadership and financial positions. These are the administrators who make decisions about funding for a sim program. Next determine the goals and objectives of a needs assessment to identify specific needs within the facility. The presenters created a SWOT analysis to use as a talking point with the stakeholders. The SWOT consists of internal strengths and weaknesses and external opportunities and threats. Identify training gaps, program specific requirements, GME requirements, accreditation requirements, teaching key skills, and research.

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Consider cost avoidance by calculating how each of these requirements or needs will be affected if the sim program is funded as opposed to what could happen if no simulation is available. For example, calculate the cost of central line infections from lawsuits, extended patient stays and lack of insurance reimbursement. Then calculate the cost of simulation including staff development time, staff attendance, sim equipment and supplies. Since the number of central line infections could be considerably reduced by simulation, funding was provided for simulation training. Some GME requires training and simulation in healthcare.

Gather all the data together in a report which can be used to request funding for simulation staff including protected FTE for faculty, equipment and supplies and maintenance fees. Utilize the SWOT analysis to refine goals and objectives. Include multiple solutions when writing a needs assessment for leadership. Finally consider use of the simulation facilities to outside organizations such as ACLS training, Stop The Bleed or Active Shooter to generate funds to support the simulation lab.

The Ultimate Simulation Scenario Blueprint

Dr. C. Eric McCoy and his colleagues from the UCI Department of Emergency Medicine presented a fast paced learning lab entitled The Ultimate Simulation Scenario Blueprint. What is interesting about his work is that all of the scenarios that have been developed so far are available for free on Thesimbook.com website. There are no copyright, journal or subscription fees just free scenarios. He hopes to create a repository of scenarios for anyone to use and he encourages people to use the template and add scenarios to the website. The template is available on the website under the tab IMSH2020.

The workshop walked participants through every step of scenario creation including: case title, description, diagnosis, target audience, educational rationales, learner objectives, scenario preparation, environment, confederates and supporting materials, simulation event table and debriefing. Time was spent on learning how to write learning objectives. An example might be “by the end of this simulation scenario, the learner will be able to identify sinus tachycardia on the ekg”. The scenario will also need a short paragraph explaining the educational rationale for the scenario.

A decision must be made as to how to measure if the learner has met the learning objectives or in other words, what are the critical actions the learner must perform. Information must be provided to the learner about the background of the case and the initial clinical presentation of the patient. The educator must also decide how the scenario will unfold/progress and a decision point known as the nodal point is chosen. This is the point in the scenario when a learner has to make a decision to go in one way or another. The progression or direction of the scenario will depend on that the decision the learner makes at the nodal point.

Dr. McCoy notes that scenarios must be supported by the highest quality clinical evidence currently available. He also provides information about obtaining the latest treatment for clinical practice by using the 6S hierarchy of evidence. If this sounds a bit overwhelming, the website provides a detailed template for scenario development. The presentation and website provide and an amazing resource for scenario writing. Thank you!

Tuesday Plenary by Dr. Tim Draycott

Professor Tim Draycott, MD, BSc, MBBS, FRCOG, Consultant Obstetrician at Southmead Hospital and the University of Bristol delivered Tuesday’s IMSH plenary session. With his dry sense of British humor, Dr. Draycott shared his enthusiasm for simulation along with his skepticism. He discussed how simulation can work to improve patient outcomes but acknowledges that simulation does not work all the time and therefore, practitioners must look at the research data to show proof that a particular training (simulation) works before widespread implementation.

He suggested that medicine should be likened to the fire service rather than the aviation industry, since many days firemen drill and put out small fires but on rare occasions they have to run into a burning building and put their lives at risk. He suggests we need to learn our systems rather than learn new knowledge. He also favors checklists and prompts which should be read during critical inventions. During these occasions, staff may be stressed and liable to forget protocol steps. Having a checklist and practicing implementation of the steps ensures that all steps are included when a critical event occurs.

Surprisingly the UK pays more for OB complications than the United States. In response to the mother and/or baby mortality or injury, Dr. Draycott founded the worldwide non-profit PROMPT Foundation which provides training for maternity units including helping midwives, obstetricians, anaesthetists and other maternity team members be safer and more effective practitioners.

He is an enthusiastic proponent of checkoff lists/algorithms which he believes must be practiced in each facility where they are to be used. Following PROMPT implementation, mortality rates, cost and long term disability went down in multiple facilities around the world.

Dr. Draycott noted that simulation is the laboratory bench of patient safety and that persuading healthcare institutions to fund simulation should be presented not in terms of cost but rather in terms of value. Further training is the scaffold for safe care. Further recommendations include senior staff should role model, hierarchies should be flattened, standardizations should be flexible and stabilized by the use of boxes/algorithms.

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