By Michael V. Frey, RRT-NPS
Clinical simulation labs have become an important modality in the health field for a number of reasons—from the need to improve patient mortality rates to broadening health care practitioner experience levels amid an increasingly hard to staff environment. Health care practitioners, including respiratory therapists, must be properly trained to handle a variety of situations. And a clinical simulation lab can provide that training. Still, there are many questions to be answered before heading into a simulation lab arena.
The purpose of the simulation lab is to create an environment that mimics real world conditions to enhance the practitioner’s education, or to train them so their actions become routine in times of stress. As Howard Polden, RN, flight operations manager of Medford, Ore-based Mercy Flights, states, “There are not enough clinical events to be able to train an entire staff appropriately. The lab provides a place of safe instruction and an ability to increase their knowledge base.”
Clinical simulation labs have greatly evolved—from the simple mannequin head on which to practice intubations to a room of complex computer equipment providing a controlled environment that mimics all the variable factors of an incident, making realism a major component throughout the event. The simulation lab provides a safe environment for health care practitioners to learn to diagnose, assess, and treat patients without the fear of doing harm to the patients. In addition, it provides a myriad of opportunities to challenge practitioners, in an environment where they are given permission to make mistakes and learn from them. Polden finds this invaluable for his staff at Mercy Flights. “Simulation labs are unparalleled in this arena. For Mercy Flights, you cannot get these type of situations with any regularity for proper training of the entire staff,” he says. As a result, the use of clinical simulation labs is one of the most effective and immediate ways to assess and improve patient safety, and to help practitioners keep their skills current.
Clinical Simulation Lab Setups
Clinical simulation labs are varied in their setups and uses throughout the United States. Mercy Flights’ setup is unique in that its clinical simulation lab mimics an ambulance environment. The lab has four cameras to allow for recording and assessing the situation from all angles; this provides participating practitioners and observing staff with the ability to review and correct each moment. The lab also is equipped with audio capabilities and a computer-controlled mannequin to simulate real-life patient situations. While the monitors show current patient conditions, the “patient” also can communicate verbally according to the situation.
The mannequin exhibits many real-life vital signs, as needed, to produce a true to life scenario. Computers help control heart and respiratory rates. Some mannequin models also allow for diaphoresis. According to Polden, the closer the environment can come to a realistic scene, the better it is for the practitioner to expedite and appreciate their knowledge base, allowing this learning experience to improve the skill set. In the near future, the ambulance lab at Mercy Flights also will be able to convert to a rescue helicopter mode, including the use of Carter boxes for the flight team to plug in their helmets and microphones for a realistic communications experience.
Beyond the clinical environment, simulation labs also can be invaluable in the education domain to help supplement the classroom experience. Often students are relegated to the back of the room during crisis situations, limiting the observation opportunities. Simulation labs offer them an opportunity for hands-on experience and up-close observation to improve their training and better prepare them for realistic clinical experiences.
Cost Versus Benefit
Often the cost of running a simulation lab and paying staff for renewing competencies can be an obstacle to training efforts. However, as Polden points out, a clinical simulation lab “can be run as minimally cost intrusive.” The initial expense of the front-end installation is the major obstacle for many programs considering this route. However, once the system is installed, there are many cost-effective ways to train the staff.
At Mercy Flights, the crew trains during their downtime when on duty. According to Polden, the staff agreed that perfecting their skills is more enjoyable than the boredom of downtime that a flight/ambulance team inevitably sees. However, if staff must be brought in for extra training time beyond their normal work hours, the experience and the results are well worth the salary cost. One area in which a facility will see a financial benefit is in avoiding the costly, and possibly deadly, errors that come when a staff member is poorly trained.
In today’s modern health care system, the properly trained health practitioner is well worth the cost of minimal training. Many hospitals understand this and have set aside a clinical resource day, which includes simulation training. To really measure cost-effectiveness, health care practitioners must look at current clinical competence levels and compare them to where they want to be. As competence levels are increased through training, mistakes will decrease, thus avoiding potentially life-threatening scenarios that put the patient at risk, and in the end money will be saved.
The effectiveness of clinical simulation labs is a little more difficult to measure objectively. While many attempts have been made to quantify whether the cost analysis makes it worthwhile to run a clinical simulation lab, in the end, the increased staff competency in being able to recognize and hopefully better react to an emergent situation will save the organization both time and money. The potential for lives saved is immeasurable. But beyond numbers, in today’s competitive health care environment, a well-educated and skilled group of employees is invaluable.
The practice of medicine has changed over time. Patients and their families expect perfection, or as close to it as possible; thus, health care facilities need to set a goal of giving health care practitioners as much practice as possible. And the old adage, “practice makes perfect,” is in fact increasingly resonating with health care professionals.
Facilities that have adopted simulation labs for training recognize that it removes a level of risk to the patient, while allowing for skill development and competency. When finally faced with a real-world situation, health care practitioners, as indicated by Cook et al, are better equipped to implement the knowledge and skills necessary for patient care.1 And as the demand for more health care workers in the field increases, the risk of “new graduates” increases. The need for clinical simulation training for this subset alone is paramount. Such training during orientation periods could go a long way in improving patient safety as facilities add staff.
The reality is that respiratory therapy managers will need to utilize simulation labs for training their current staff, especially as they become more and more specialized. Exposure to different scenarios outside their competencies will be invaluable to keep them current. In addition, the use of evidence-based medicine and an increase in the use of protocols mean that respiratory therapists will need to be trained and tested on new skills in order to be efficient and safe in their delivery of respiratory therapy programs to patients. Respiratory therapy departments can use clinical simulation lab programs to help this training and expedite new skill sets within a minimal amount of time.
The use of simulation programs continues to proliferate throughout the country as the need for increased skill sets, in less time, and cost efficiency becomes increasingly important. Respiratory departments have an opportunity here to lead the way forward. ?
Michael V. Frey, RRT-NPS, is clinical consultant, alternate care, CareFusion, Yorba Linda, Calif. For further information, contact [email protected].
1. Cook DA, Hatala R, Brydges R, et al. Technology-enhanced simulation for health professions education. JAMA. 2011;306:978-88.
Passiment M, Sacks H, Huang G. Medical simulation in medical education: results of an AAMC survey. 2011. Available at: www.aamc.org/download/259760/data/medicalsimulationinmedicaleducationanaamcsurvey.pdf Accessed November 22, 2011
Walsh BK, Gentile MA, Grenier BM. Orienting new respiratory therapists into the neonatal/pediatric environment: A survey of educators and managers. Respir Care. 2011;56:1122-9.
University of Florida Health Science Center Jacksonville. Center for Simulation Education and Safety Research. Available at: [removed]www.hscj.ufl.edu/csesar/about.asp[/removed]. Accessed November 3, 2011