We spoke recently with James Spaulding, BSN, RN, CCRN, who is the Simulation Lab Coordinator at Saint Peter’s University Hospital. Spaulding told us how the lab provides valuable, hands-on training for physicians and other health care professionals to advance quality, safety and cost containment.
As the Sim Lab coordinator, can you explain the overall concept?
Dr. Nayan Kothari, Chief Academic Officer for Saint Peter’s University Hospital, noticed that with the advent of new technologies there was a decline in hands-on interaction and conversations with patients. He envisioned two elements of the simulation lab. First, the technical aspects could be taught with robots, or medical mannequins. The second part was a focus on bedside medicine, using actors to pose as patients with a script and diagnosis. We want to prepare young doctors in having difficult conversations with patients, perhaps breaking bad news such as a diagnosis of cancer, or discussing end-of-life treatment. We provide feedback of what they could do differently, and they get experience before they interact with real patients. We work with first-, second-, or third-year residents as well as attending physicians and other health care professionals.
How does the work in the Simulation Lab improve health care quality?
We take a situation — maybe a medical emergency that already has happened — where we want the outcome improved. We take that situation and work it into the software of the medical mannequins. We build in objectives; perhaps a patient is really deteriorating. We can provide feedback in real time. How did the doctor perform? What did they miss? Did they think of a particular medicine? In medicine, these emergencies don’t happen all the time, thankfully. So this is a high volume, low risk training exercise. For instance, we have a mannequin mom that delivers a full-term baby but then experiences a hemorrhage. We run the simulation with the team of nurses and obstetric residents and we can run through this repeatedly — wherein the real world this might happen once every four or five months. We run simulations on situations such as drowning, a choking baby, cardiac arrhythmia, and all pediatric advance life support situations. With hands-on experience, clinicians remember the information better and are better prepared for the real world.
What is the biggest mistake you see health care professionals make?
Occasionally, there could be a misdiagnosis or the wrong medication dispensed. We created the Simulation Lab to provide a culture of safe learning. After we run these training exercises, we see people communicate better with each other, with nurses, and with patients. Everything that happens is on video and we can screen the video to a group of peers. Everyone walks away with more knowledge and confidence.
Does the Sim Lab lower health care costs?
Our aim is to train health care professionals to provide the highest quality care, and there are examples where this effort can reduce costs. For instance, one simulation involves a nurse recognizing when a patient starts to decline. If we can intervene early we may avoid an ICU admission. We’re teaching healthcare professionals to pick up on things before they escalate.
How is your Simulation Laboratory supported?
We got off the ground through grants and donations and we primarily work with physicians and also health care professionals such as nurses and respiratory therapists. We’re generating some income by providing Basic Life Support and Advanced Life Support training. We also work with sub-acute facilities that send their staff to us to brush up on clinical skills and to learn how to deal with emergencies. We’re working with long-term care facilities to see if we can prevent readmissions to hospitals. So we will look at data to see if we reduce readmissions and make a real difference for patients.