Wednesday 27 March 2013

Another Day, Another Doll

Sim NewB placed in a live delivery suite
I should start this blog with an apology really. My colleagues in Simulation not to mention industry will be apoplectic at me referring to a piece of kit that can cost anywhere from £15k to £65K as a doll! In my defence I have to plead poetic licence. Frankly Another Day, Another High Fidelity Simulator just didn't scan as well.
 
Nor should anyone infer mundanity or boredom from the title, because todays activity at the Liverpool Women's Hospital was anything but mundane. No sooner had the dust settled on our Aintree and Royal Liverpool exercises, yet another NHS Trust in our region, that sees simulation training as vital in maintaining patient safety called us in to assist with some training. We were only too eager to oblige.
 
The scene-  a brand new  delivery suite in the actual hospital, The simulator - Sim NewB, The Team - Neonatal Resuscitation Team, The learning objectives - Managing Neonatal Crises and Team Resource Management. It took a fairly big team to deliver this. There were three of us from Centre for Simulation and Patient Safety. One of us had to control the "Baby" another to facilitate in the guise of a student nurse on placement, and a third to ensure the action was filmed for the debrief. Then we had our team from the Women's, two Neonatologists, and two Midwives. Sometimes in situ simulation is as labour intensive as doing it in a centre. the investment is worthwhile though.

So how was it done? To be fair Sim NewB, whilst in my view a very robust and effective simulator, out of the box its not wireless, nor is it particularly portable. Controlling the mannequin from inside the room was always going to be a challenge unless we were prepared to have trailing cables accross the floor. Fortunately Laerdal the simulator's manufacturers had agreed to allow us to "road test" Sim Pad. this allowed us to remotely control NewB from inside the room without any conspicuous wiring.
 
At this point it is probably worth sharing my thoughts on this new piece of kit. Well for starters it definitely allows for easier and wireless control of the mannequin. The software interface and touch screen is very intuitive and user friendly.The device is truly "handheld" I was able to position myself next to "mum" and pretend to be "Dad" whilst controlling the scenario with what would have looked like a common tablet device. In fact I could keep it entirely from view most of the time. The wireless range is also impressive, and we experienced no drop out or interference from the Trust's wireless networks or other mobile devices.The battery life was good and the new link box is small and discrete.
 
It's a shame that we still needed to use the noisy and bulky compressor. If you are reading Laerdal this is the next thing you need to fix (I hear whispers they're working on that). Not having that box attached to the baby would have allowed us to move the simulator out of the room to another location like Neonatal Intensive Care for example. We could control most of the features, such as seizures, heart rate, rspiratory rate and SpO2 for example. However, the cyanosis didn't seem to work, and trainees were still able to ventilate the mannequin even with the lung resistance on full and chest movement switched off. These problems don't occur when using a wired laptop controller. Other features that would enhance Sim Pad would be CO2 monitoring, and the ability to display just a SpO2 and Heart Rate without an ECG Rhythm.
 
Now to be fair I am told that the company are working on these features for future upgrades, it's just a shame they weren't available when the product was rolled out. Another thing to consider is that Sim Pad is never intended to work with Sim Baby, and at present doesn't operate Sim Mom or SimMan 3G (although there are plans to bring these two mannequins online). people may decide to wait for it to interact with these two simulators before investing in the kit. It does also control Sim Junior though.
 
Having said all of this the scenarios today ran very well and the learning objectives were met. In particular the Neonatal Team were able to thoroughly test how their staff coped with new equipment and a new unit without any risk to an actual baby. This is one of the major advantages to hospitals of utilising simulation. You can really test your systems safely, identify latent conditions for error causation and remove them.
 
In the last three weeks three of our hospitals in the North West of England have taken full advantage of what simulation has to offer. I would argue their patients are safer as a result. We would never step on an aeroplane if we knew the pilot had never been in a flight simulator why should healthcare be any different.

See pictures at www.facebook.com/CentreforSimulationandPatientSafety 

Tuesday 26 March 2013

New Horizons in Simulation and Patient Safety


I’m Back! It’s been a while, but please don’t mistake my delay in revisiting the blogosphere as a lack of activity in the world of social media. As you will see from my latest effort we have been very busy indeed.

Last week saw the profile of simulation and human factors in healthcare soar to new levels. The BBC broadcast a fascinating documentary as part of its “Horizon” series entitled “How to avoid mistakes in surgery”. The title was slightly misleading but aunty beeb can be forgiven for this, as they undoubtedly had one eye on the ratings. The programme contained little new material for those of us who have been working in simulation and patient safety for many years.

However, the impact of this on the public consciousness is not to be underestimated. Well done to Dr Kevin Fong also for making the subject matter so accessible. It is also worth mentioning that many of us would have felt entirely vindicated in our work as a result of this broadcast.

For us at the Centre for Simulation and Patient Safety in the North West of England, this much needed injection of vindication was occurring against the backdrop of our attempts to move simulation to new horizons in our own region (did you see what I did there?). We have been developing our capabilities around “in situ” simulation for some time. We have run a number of successful exercises within actual hospital settings. These have been single patient events, short in duration. A sort of “guerrilla sim” approach if you like.

However flushed with a heady mix of confidence, enthusiasm and a desire to break out of the confines of the Simulation Centre, we decided to up the ante somewhat. First of all came the Medical Emergency Team (MET) exercise. The recipe, sprinkle liberally four simulated patients around Aintree Hospital, Liverpool (including one collapsed outside Starbucks at the main entrance, my personal favourite) bleep the MET and stand back and watch as they go to work saving lives, albeit plastic lives. The results were amazing. The hospital was buzzing as the activity unfolded throughout the day. Visitors and patients appeared delighted, staff stood in awe. More importantly the MET found the experience and practice incredibly beneficial.

All of this would have been a very local affair if it wasn’t for social media, or more specifically Facebook. In my last blog I promised we would make a much bigger splash in these waters, and I think I can say we have delivered. Our facebook (shameless plug www.facebook.com/CentreforSimulationandPatientSafety) page’s reach rose from 16 in January to 2600 in February as a result of this exercise. By posting photos of the activity we were able to capture the imaginations of facebook users and raise the profile of our work.

So we come to last week. How could we capitalise on our successes in February. We got wind of the Horizon documentary following an email blast from a local trust, and the idea of a live web chat on Facebook just seemed a logical way to engage with our new found followers. Also, as luck would have it, we were planning a major simulation exercise at the Royal Liverpool Hospital on the same day as the broadcast.

This one was really testing the limits of our capabilities but thanks to the collaborative approach of the emergency department team and the Education team at the Royal we were able to pull of what I feel was one of our most spectacular simulation exercises yet. So what did we plan? Take not one, not two but three simulated patients into a live inner city emergency department and really test the systems and team work in a positive way with a focus on finding latent errors and team resource management.

We only managed to do two patients, as actual patients should of course always come first. The last thing we wanted was to jeopardise patient safet by carrying out a patient safety exercise! However we did manage to bring a simulated trauma and a patient with pneumonia into the department and have them managed by the actual hospital teams in their own clinical environments. 

This included a transfer to CT scan (see Facebook for a hilarious photo of Sim Man 3G’s head CT scan) and a transfer to Theatre. In the case of the septic patient a critical care review was arranged and the “patient" was intubated in the emergency department and made ready for transfer before the scenario was terminated.

So we had now carried out two highly visible and successful exercises, and had an eager audience ready to visit our social media pages to see the images and footage. How else could we engage with them? This is where the web chat came into its own. A perfect storm of simulation activity on the ground and in the workplaces, highlighting the importance of safety and practice and a wonderful opportunity for all of that to be crystallised into a discussion and reflective process based around a popular science programme on national television.

The result was 350 people following our live chat during the programme and 48 people contributing to the discussion, even though the multi-tasking involved in “facebooking” whilst trying to watch the telly caused some to lose situational awareness (human factors get everywhere don’t they). I have to say my enjoyment of the programme was enhanced by the ability to discuss it with others as it happened. Trust me we will be doing it again. We have to find someway to keep our social media audience happy, especially as they have grown in number to 3500.

I’ll be back soon………honest.