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Seattle Children’s unique approach brings simulation training where it’s needed – at the clinical worksite.

Seattle Children’s takes a unique approach to using simulation as a training tool for clinicians. Rather than investing in expensive, flashy simulation training facilities, Children’s deliberately chose a nimble, flexible, mobile route that brings hands-on, team-building training precisely where it’s needed – at the site of care.

The philosophy is that training caregivers in their worksites provides a more complete learning experience – it heightens participants’ cognitive and kinetic learning while testing the institutional systems, policies and procedures that shape their work.

Simulation training gets to the “whys and hows” of what works, and informs everything from environment issues and room design to how to reduce medical errors. When done at sites of care, the improvements are greatest.

Seattle Children's deliberately chose a nimble, flexible, mobile route that brings hands-on, team-building training precisely where it's needed - at the site of care.

Have SimBaby, will travel

In 2004, Seattle Children’s was the first pediatric hospital to acquire SimBaby (a simulator with realistic anatomy and clinical functionality of an infant), and the simulation training program here has been growing ever since.

In 2010, several advances to formalize the program’s curriculum were made and a second technician was added. Approximately 600 simulation sessions are completed each year at Children’s – up to 20 in a given week. Some of the approximately 4,000 trainees from departments throughout the hospital participate in multiple sessions.

There are 60 possible training sessions that range from very basic, with one or two people practicing a simple technique or procedure, to a fully staged scenario with full code teams and real-time action working on a high-tech SimBaby simulator.

Reubens 220x130Children’s currently has three SimBaby infant mannequins, including a SimNewB that resembles a smaller newborn. A fourth mannequin that will stand in for an older, larger child is on the horizon. The mannequins cost approximately $46,000 each, including their software and gear. Children’s also has life-like “task trainers” of different sizes, including three “arms” for intravenous simulations and six “heads” used for intubation practice.

“The experiences we have accumulated through mobile simulations allow us to understand the unique training needs of work areas around the hospital,” says Dr. Daniel Rubens, an operating room anesthesiologist and clinical director of the simulation program. “With our approach, we deliver simulations to specific work areas, addressing the different needs for each site and every team. We give providers what they need, where they need it.”

Creating new standards for Emergency Department (ED) care

Stone 220x130 Emergency physicians Kimberly Stone and Jennifer Reid co-direct pediatric emergency medicine simulation at Children’s. They designed, and are now testing, a standardized resuscitation curriculum that includes nine of the most common pediatric emergency conditions that require swift, stellar team dynamics:

  • Asthma
  • Abdominal trauma
  • Anaphylactic shock
  • Closed head injury
  • Hypovolemic shock
  • Septic shock\
  • Seizure
  • Supraventricular tachycardia (an abnormal, racing heartbeat)
  • Ventricular fibrillation (rapid, uncoordinated, ineffective heart contractions)

This curriculum forms the core of emergency training for Children’s 100 pediatric residents who are expected to be able to manage these emergency care conditions by the time they have completed their residency.

The resuscitation curriculum also forms the basis for the focused ED simulation curriculum, which all ED physicians and nurses participate in at least twice a year. All ED scenarios take place where real cases are treated: in the resuscitation room near the ambulance bay doors.

“These scenarios and mock codes teach situational awareness, show how a team needs to function well together during a crisis, and verify important procedures and policies for residents,” says Dr. Benjamin Mackowiak, chief pediatric resident at Children’s. “All interns and residents need to learn how to work in crisis, under stress, when the noise level and adrenalin are running high. Simulation training provides safe ways for residents and attending staff to practice.”

In 2010, Stone and Reid created a unique Simulation Team Assessment Tool, called the “STAT,” to measure training outcomes and team effectiveness. STAT scoring determines whether desired results and outcomes were achieved for the SimBaby “patient,” illustrating the patient-centered focus of the training.

Safe way to practice

The desire for simulation training comes from throughout the hospital, including the operating rooms in which simulation scenarios are run for full teams – surgeons, scrub techs, anesthesia teams, circulators and support staff. Pulling together the resources – people, equipment and time – that are needed to run these gowned-up, scrubbed-in, real-time scenarios with SimBaby is no small feat, but the hospital sees the value and supports it.

“It can be a challenge, but it’s worth it,” says Rubens. “Surgeons and anesthesiologists get to practice changing roles and team leadership during crisis when a mock “surgery” goes awry. We can see how our rooms and teams function together.”

Emphasis on simulation training has grown over the last few years, and Rubens, Stone and Reid are making a difference by studying effectiveness and advancing how training occurs.

Reid 220x130Data and measurement are the keys to establishing new standards. Rubens hopes to publish findings on operating room and other simulation program successes, ultimately showing that simulation training leads to improved team performance and shorter times to deliver necessary care.

As members of the Examining Pediatric Resuscitation Education with Simulation and Scripting (EXPRESS) research collaborative, Stone and Reid are working to identify best practices for resuscitation education and debriefing. Also, through their membership in the Patient Outcomes in Simulation Education (POISE) Network, they are working to develop and disseminate robust simulation-based education interventions that can improve pediatric health outcomes.

“It’s magic,” says Reid. “With our simulation programs, we can push the pause and redo buttons. It’s our best way to freeze time and learn how to solve real problems in real ways.”

600 simulation sessions are completed each year at Seattle Children's.