June 16, 2020By Lance Baily

Healthcare Simulation Center Design: Lessons From Leading Technical Experts

Comprehensive Healthcare Simulation: Operations, Technology, and Innovative Practice is the leading medical simulation book for those administrating or operating sim lab technologies, spaces, staff and processes. From the basic theories to advanced practices, the latest healthcare simulation book has been praised by readers as a “must read” item for anyone operating, managing, or starting a medical simulation center. Here we take a closer look at the chapter on “Infrastructure and Center Design” from leading experts Ferooz Sekandarpoor, Simulation Technology Specialist from the University of British Columba and Present of the SimGHOSTS Organization, Eduardo R. Luevano Associate Director at Texas Tech University Health Sciences Center and Dr. Scott B. Crawford, Associate Professor and Director of the Training and Educational Center for Healthcare Simulation at TTUHSC El Paso. The excerpts presented below are just some of the chapter’s numerous ways to help Clinical Simulation Champions design and build simulation lab spaces!

When planning for the creation of a simulation center, the stakeholders and end users must first be identified. Organizing committees should both reflect on the immediate educational needs of currently existing programs and the potential needs of future expansions within the next decade. Many accrediting bodies have mandates for a curriculum allowing for interprofessional education, and simulation centers are frequently called upon to meet this requirement.

Having an interprofessional curriculum means there will be multiple disciplines/specialties using the center (e.g., nursing, emergency medicine, surgery, anesthesia, pediatrics, obstetrics and gynecology, family medicine, pharmacy and allied health professionals just to name a few). Gathering input from each potential specialty to capture their requirements at the planning stage will ensure the center is designed to support each program’s curriculum.

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Simulation labs are generally located at clinical academic campuses or may be integrated into healthcare centers such as hospitals consisting of one or several dozen individual simulation rooms. Each room can typically accommodate from five to ten students plus one or more educators/facilitators beyond the space required for training devices, such as beds with manikins. These numbers are estimates, and actual use will depend on local logistic requirements and educational practice. Constraining room size will maximize space utilization but may make simulations too crowded for multiple team members to participate.

Larger rooms will allow for more learners but that does necessarily translate into effective learning, as learners can miss out on the experiential component if too many individuals are in the room. While more intimate groups are often preferred, the American College of Surgeons Program for the Accreditation of Education Institutes requires at least one space that can accommodate 20 learners at a time for hands on training. These simulation spaces are used by students, residents, and healthcare providers to practice performing clinical procedures within a safe learn- ing environment. Procedures can be conducted on a variety of simulated experiences including standardized patients (actors), task trainers, full-body patient simulators, or virtual patient devices.

When designing a simulation lab space, special consideration should be taken to ensure that the orientation of the room closely mirrors the clinical environment. This includes having access to an examination table and any medical equipment associated with procedures. This equipment can include headwall systems, portable diagnostic equipment, desks, or supplies from crash carts such as medications or oxygen masks. Just like in a real patient setting, the vital signs monitor should be placed where it can be seen by simulation participants. A whiteboard is commonly available to learners in sim labs for writing down patient information and treatment plans. This medium can allow sharing of information with others in the room and can help observers in the control room review the thought process and plan of the learners. A computer with internet access should be present in the room both to assist with demonstrating educational material and allow access to simulation-specific resources.

A speaker phone is another important item to be considered as learners will frequently need to call on other healthcare professionals during simulated experiences. Determining how this phone can connect to your simulation control room is important to consider as well. If there is no need to call phones outside of the simulation center, internal communication is possible using an IP-PBX-based calling system such as Asterisk or 3CX [9]. However, enabling this phone to call outside numbers can help during trouble shooting sessions with higher levels of technical support. The HSTS must be able to work with vendors and customer support personnel while in the same space as the device requiring support. Similarly, both for educational and diagnostic purposes, having ready access to available ethernet ports or wireless access should be considered to support expandability and additional devices depend- ing on the use of the room and needs of the center.

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An additional audio consideration is the ability to talk through a speaker or existing manikin hardware in a real-time manner to allow natural interaction between the participants and patient. A separate audio cable run to the headwall for this purpose is becoming a common practice in many simulation designs. Some centers have even added a voice modulator for use with this speaker connection to allow the simulation operator to portray different voices or patient types such as male, female, geriatric, or child, regardless of the demographics of the operator.

Debriefing spaces and video debriefing systems should have the ability to immediately replay sessions for review with annotations, and video cueing, enabling the ability to jump to a specific point for review and discussion. Some systems can allow learner access to view recordings of their own interactions for self-reflection and learning either on-campus or off. Access to recordings and the retention of stored items is an institution-dependent decision that should be described in detail in a policy. Some centers may keep a recording for only a few days to a week, while others maintain this data for the entire duration of matriculation of a learner.

No correct answer exists, but the potential medical-legal ramifications about retrospective review of learner performance have driven concern for policy by many administrators. Separate from this administrative concern is the infrastructure requirements for long-term archiving and storage of data heavy video files. Each simulation center, if associated with a larger institution, must seek advice from accrediting bodies for specific policies and procedures.

A key principle in designing simulation lab infrastructure is flexibility. This reflects the fact that educational and technology requirements will likely change over time as curriculum, clinical standards, and technologies evolve. For example, one element of creating a flexible design might include specifying a moderate amount of additional conduit capacity to allow for future changes to wiring needs. Floor boxes are one way to provide this type of connectivity and expansion but usually require planning during a new build for structural reasons because of the significant depth of cutout required for in-floor installation.

Separate from standard Americans with Disabilities (ADA) and wheelchair access requirements, hallways and doorways need to be large enough to accommodate med- ical equipment movement into and out of rooms; this includes elevators. A full-sized hospital bed is 40′′ × 91′′, and even the smaller transportation stretchers are still 32′′ × 83′′ [15, 16]. Standard-sized office doors and hallway widths do not accommodate equipment of this size. Hallway widths of 8–10 ft are common, and some centers add cutouts along hallways or corridors to allow gurneys or other equipment to be stored or moved out of the main walking areas.

A typical simulation room for use with a manikin at many medical school ranges in size from approximately 300 to 450 ft2 (see Table 9.1); some larger rooms may be needed to accommodate multiple manikins or special activities such as operating theaters or obstetrical delivery rooms. An intermediate-sized room approximately 13 ft × 15 ft (195 ft2) is used by some centers for manikin- based simulation training for up to 6–7 participants. A smaller hospital gurney, instead of a full-sized hospital bed, can allow some additional floor space if needed. A smaller room will limit the number of learners that can be present at one time, especially when considering the additional medical equipment such as sinks, medication carts, ventilators, and code carts that must also be present during training. Room size and egress considerations will determine final appropriate occupancy for safety considerations.

In addition to the audio/video intensive, directly observed, single-patient room occupied by a manikin patient simulator, a large classroom-type room with multiple beds along the sides may be useful in many centers. This style of room is commonly used by many nursing programs to teach and assess procedure and bedside skills. This type of room may not be practical for all types of learners but can allow a mixture of didactic lectures and group skill practice. The bed spaces around the outside of the room may be separated by curtains to still allow some separation between learners. Consider that each bed may still need a nearly 8 ft × 10 ft space inside of the curtain to allow trainees or instructors to fit around the sides of the bed.

Storage space is a very important consideration in the overall design plan. The required size for the storage room(s) will depend upon the overall size of simulation labs in a given facility, the number of learners or groups supported, and the different simulation educational tools used. The room must be large enough to accommodate moveable carts and clinical equipment, such as IV poles and ventilators, as well as simulation supplies and manikins. One potential design is to place shelving carts and/or cabinets at a height of 5 ft or higher on one or more walls, allowing large pieces of equipment to be stored below. Six-feet-long cabinets or shelving carts can be used to store additional manikins.

There are many configurations for control rooms used in monitoring and controlling full-body manikins in a high-immersion simulation space. A control room can be a single room space or one of several small desk cutouts in a long control/access hall- way. Control rooms can also be enclosed spaces with shared observation to two or more rooms or isolated cubical-style observation booths without direct access or observation to the simulation room space at all. The pros and cons about space efficiency, cost, access, and acoustics will need to be evaluated by each center and the intended use evaluated relative to the function of the control room and the room it is observing.

Of course, this is only a handful of the concepts outline in this chapter, so for all the best advice we recommend purchasing the book below!

Previously We Shared Chapter Excerpts on:

More Key Take Aways From Latest Simulation Operations Book Include:

  • Practical guide helps prepare professionals for the broad scope of simulation in healthcare
  • Defines the domains of medical simulation operations
  • Focuses on the development of the healthcare simulation technology specialist
  • Written and edited by leaders in the field of clinical simulation

Written and edited by leaders in the field, Comprehensive Healthcare Simulation: Operations, Technology, and Innovative Practice is optimized for a variety of learners, including healthcare educators, simulation directors, as well as those looking to pursue a career in simulation operations as healthcare simulation technology specialists. Grab your copy today:

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