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 

3 comments:

  1. Great blog, Jeff. I can see a professional blogger in the making.

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  2. Thank you Tim check out www.jeffgoulding.com for my personal blog

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