October 29, 2020By Lindsey Nolen

Simterviews: Medical Simulation Expert Interviews | UPMC Director for Patient Safety, Dr. Paul Phrampus – Part 2

HealthySimulation.com’s new healthcare simulation expert interview series “Simterviews” kicked off its first conversation with Dr. Paul Phrampus, MD, Director of the Peter M. Winter Institute for Simulation, Education and Research (WISER), and professor in the Departments of Emergency Medicine and Anesthesiology at the University Of Pittsburgh School Of Medicine. In addition, he serves as the Medical Director for Patient Safety of the UPMC Health System and is a Past President for the Society for Simulation in Healthcare (SSH). This is the second part of a 2-part launch of this new ongoing Simterview series, HealthySimulation.com’s Content Director Lindsey Nolen receives powerful advice from Dr. Phrampus on advancing clinical simulation, responding to COVID-19 restrictions, Maximizing ROI with data tracking and connecting Patient Safety to Simulation outcomes. Get caught up first with Phrampus Simterview Part 1.

HealthySim: What is something that is currently exciting you about the healthcare simulation industry right now? (A book, a website, a product, a service, research, conference, etc.)

Dr. Paul Phrampus: One of the things that is interesting is what the COVID-19 disruption is doing. It’s really causing a retrenchment in some cases of evaluating what we can do and how we can do it. Those activities have ranged from somewhat unfortunate where people say we shouldn’t be doing medical simulation because we’re not essential and we might be hurting people to a full-on continuation of what you’re doing mentality.

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The exciting part is the pressures and the disruption that that’s putting on everybody to rethink how they can do their work while keeping people safe. I think that is very exciting. I also think that how technology continues to advance in clinical simulation by getting more deployable, somewhat cost-effective and ideas that flow in terms of creative uses of healthcare simulation are more exciting now than ever.

HealthySim: How has your institution responded to COVID-19? What were lessons learned?

Dr. Paul Phrampus: WISER is in a situation where we responded to COVID-19 in a number of ways. We are committed as an institution to believe that healthcare simulation is absolutely essential. We at the University of Pittsburgh and the UPMC Health System have wrapped clinical simulation in the quality, care and safety of all of our patients at our 30-plus hospitals. That’s a challenge because we can’t just say “OK, turn it off, pause.”

We have taken advantage of the description caused by COVID-19 to reevaluate what we are doing, how we are doing it and how we can continue training but reengineering some of our old ideas to realign with basic concepts of COVID-19 safety: social distancing, masking, spreading out classrooms and changing the studio-to-instructor ratio in classes. We’ve also held a number of seminars for the SSH, talking about our efforts to pioneer remote healthcare simulation. We’ve been working on remote medical simulation for a long, long time. We’ve had a few posters at IMSH over the years.

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I think COVID-19 really sped that up and pushed us to use off-the-shelf technology like Zoom to a different level to be able to accomplish medical simulation training. We’ve been doing some clinical simulation all the way through the pandemic experience. The other thing WISER was positioned to do, because we are a research and investigation facility as well, is analyze using healthcare simulation to spin up some devices that actually went to market and became products as different safety solutions for both providers and patients as they are cared for during the pandemic.

HealthySim: Recommendations for others in terms of overcoming COVID-19 challenges?

Dr. Paul Phrampus: My biggest advice for those in charge of healthcare simulation programs is don’t accept the idea that you’re nonessential. Plan for not when COVID-19 ends, plan for how we keep this essential element of safety and quality moving through COVID-19 as safely as possible for the faculty, staff and participants. I think a lot of people have stopped everything and are trying to figure out remote healthcare simulation.

Whether you’re on the hospital side or the school side, it is an unfortunate idea that everything should stop because of COVID-19. The needs of patients are not changing. In fact, they might even be higher now than during the pre-pandemic era. We, as the healthcare simulation community who have proven ourselves to be essential over the past 25 years, need to rally and figure out how we continue simulation work and do it as safely as possible.

HealthySim: What are the goals of your blog simulatinghealthcare.net? Tell us a bit more about this resource and your inspiration for it.

Dr. Paul Phrampus: My inspiration was to create a little corner of the world where people can come and read about topics of healthcare simulation that might be timely, controversial or my ideas on the clinical simulation world. Sometimes I write things that are serious. Sometimes I write things in my tongue-in-cheek style with analogies.

I try to bring real-world analogies to address complex topics in healthcare simulation. It’s not a business endeavor, but I would like to grow the blog. I’ve recently been entertaining the idea of having guest bloggers.

HealthySim: You are both the Medical Director of Patient Safety at UPMC and Director of WISER. Tell us how these roles overlap and your efforts to bridge medical simulation and patient safety at UPMC. How is medical simulation impacting patient safety and vice versa at UPMC?

Dr. Paul Phrampus: I’ve been involved in clinical simulation at the University of Pittsburgh for 23 years, and midway through my healthcare simulation journey, I became more and more convinced of the role of clinical simulation in patient safety. That caused me to learn much more about the science of patient safety and how important patient safety is to the quality of patients that we take care of.

That journey led me to becoming certified as a professional in patient safety and ultimately as my role as Systems Safety Medical Director for the health system. I sat on this unique perch of understanding the safety issues of our patients that we serve across the UPMC health system. This puts me in a position to recommend clinical simulation for certain things that I think are impactful. It also allows me to recognize the limitations of healthcare simulation because simulation isn’t always the answer.

One of the things it’s really important for medical simulation leaders to do is to be realistic about when healthcare simulation is going to solve the problem and when it might be only part of the solution or not even any of the solution. It’s important that we use clinical simulation judiciously to create maximum impact from the investment in simulation.

That’s what I try to do at UPMC. I try to advocate for healthcare simulation when simulation is the right tool while making sure the implementation and sustainment of the healthcare simulation program is going to impact something that is a true patient safety issue at one of our hospitals or across our health system.

For many years, we’ve had advanced difficult airway programs that have relied heavily on simulation. This has impacted our mismanagement of difficult airways in a dramatic way over the years. We’ve customized those offerings which are some of the foundations of WISER from back in the ‘90s. It started out with anesthesia and we kind of blossomed from there. Now we have programs for anesthesiologists, CRMAs, paramedics, emergency physicians and intensive care physicians for difficult airway management. When I talk to other safety and quality leaders from across the country, I do believe that our rates of difficult airways being mismanaged are significantly low.

Another major patient safety initiative that we do is our central line training programs. All of our incoming residents have to be trained in a standardized, systematic way that is a blended learning platform of online education mixed with healthcare simulation to be able to place central lines in patients. That has kept our central line infection rates and medical mishaps involving central lines at a very low number, creating a dramatic amount of impact. We also work with several different subspecialties to identify critical needs where we think that the intersection of clinical simulation and safety exist.

Recently, we’ve launched a couple of new patient safety initiatives (Reference: Patient Safety Report). We’re working with the OB-GYN department to work on a medical simulation-based approach to postpartum hemorrhage and the exit procedures. These procedures are required in certain types of birth defects when there has to be a quick evacuation of the baby from the mother via a cesarean section. We used healthcare simulation there to analyze the operating room. Then through that effort, we created an education program to teach people about the procedure. We have lots of other subspecialty things we work with in terms of patient safety.

HealthySim: How has WISER been affected by COVID-19, and how is the healthcare simulation program supporting training efforts now for UPMC?

Dr. Paul Phrampus: We support training efforts for the University of Pittsburgh for all the schools of health sciences (school of medicine, school of nursing and the school of pharmacy), as well as the UPMC health system. We’ve been open throughout the entire pandemic in various levels of capacity to provide service. We’re back on full now in terms of our capabilities.

We carefully worked with all of our course directors to reengineer the way they deploy their classes to best align with safety principles, quality and best practices associated with COVID-19. We are continuing to support that effort. It’s more difficult now for our operations team with the amount of cleanings and the policing of policies and procedures, but we’re trying to reach out and help all of our course directors and faculty members to incorporate that. We’re open for business.

HealthySim: Can you elaborate on the iSim course, its curriculum and who should consider enrolling? Is it still being offered in person this year or next?

Dr. Paul Phrampus: Everybody in the world should enroll. iSim stands for “Improving Simulation Instructional Methods.” This has been a long-running collaboration between WISER and the Gordon Center at the University of Miami. We recognized a long time ago that there was a need for instructor training and faculty development. We realized early on that teaching other people how to do clinical simulation and how to use medical simulation is an important part of growing the healthcare simulation community. We created this program that eventually took on the name iSim.

The fundamentals of this course are focused on teaching people how to create scenarios and an introduction to debriefing. It’s entry level for people who want to become facile with two important components of healthcare simulation: creating a scenario and an introduction to debriefing. We also touch on assessment, but the heavy focus is on scenario design and debriefing. I say entry level, but many people come to us that are mid-career already. Some of those people simply want to reimagine how they’re approaching or doing clinical simulation. They get a lot out of it but differently than those who are just starting out.

In recent years, we’ve expanded the iSim family of programs internationally to include subspecialty programs of iSim for people who really want to take a deep dive into assessment using medical simulation. We run these courses on the occasional basis at the University of Miami and in Pittsburgh. Now, we’re reengineering things to consider doing some of the coursework entirely remote. At the moment, we do the courses on-site, so yes, they’re available. We also offer to travel to and bring the course to learners. I think this is critically important for the COVID-19 era as many places still have travel restrictions and have lots of people who don’t want to leave their area.

Some of the advantages of bringing iSim to a local site are that you get to train with the people you’re working with, you get to use your actual center and your actual equipment. There can usually be synergy that comes from that, and it’s usually a lot cheaper to bring us to you than for you to send 20 people to Pittsburgh or Miami.

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