In a packed session, teams from The Children's Hospital of Philadelphia and Lucile Packard Children's Hospital at Stanford presented simulation initiatives that have worked at their hospitals to improve quality, patient satisfaction and return on investment. There is far too much detail to go into in a short blog, but the teams have been kind enough to provide detailed outlines of their work as well as making their PowerPoint presentations available.
A quick overview of the simulation training initiatives presented:
- Dress Rehearsals and Rolling Refreshers -- A team from The Children’s Hospital of Philadelphia used a cart equipped with a Central Venous Catheter (CVC) in a simulated chest, Clinical Nurse Educators traveled to patient care units throughout the hospital, conducting “CVC Dress Rehearsals.” Cognitive and psychomotor skills were assessed and individualized immediate feedback was provided. A certified Basic Life Support (BLS) instructor utilized a cart equipped with a monitor/defibrillator and a resuscitation manikin to provide opportunities for pediatric intensive care unit (PICU) staff to simulate CPR at the patient’s bedside. These “Rolling Refreshers” allowed physicians, nurses and respiratory therapists the opportunity to practice according to the AHA guidelines with real time automated directive and corrective feedback until skill success was attained. Over 16 months, 523 nurses participated in CVC Dress Rehearsals. Improvement in nurses’ confidence, knowledge and psychomotor performance on manikins was noted. Participants were more apt to correctly perform a dressing change on a real patient. Mean CLABSI rates decreased from 5.2 to 3.2 per1000 line, contributing to improved quality of care and a substantial cost savings.
- Improving Patient Satisfaction in Ambulatory Settings Through the Use of High-Fidelity Simulation Training, Lucile Packard Children’s Hospital at Stanford -- Principles of Family-Centered Care are widely recognized and increasingly incorporated into clinical practices within pediatric ambulatory settings to improve patient and family satisfaction. Concomitantly, good communication between clinic staff and parents is recognized as key to a family-centered clinic. Yet, limited research exists that identifies theoretically-based measures for healthcare communications or effective training methods. Moreover, it is difficult to replicate the parent experience in training so that staff have a “real-experience” training. Results of two pilot studies conducted at our hospital, using a cadre of well-trained “parent actors” in a simulation training aimed at improving communication in clinic will be presented: Study #1: Improving communication skills of outpatient staff; Study #2: Improving hand-off communication with an obstetric clinic team. The combination of simulation and parent actors results in a powerful training environment. Trainees are able to practice new communication skills with well-trained parent actors in simulated but challenging communicative situations.
- Optimizing the ROI in Simulation at Your Children’s Hospital, Lucile Packard Children’s Hospital at Stanford -- Simulation is a key component of the hospital's strategic plan. Rather than viewing simulation as simply a tool for training, Lucile Packard Children's Hospital sees it as a methodology for enhancing learning and a strategy for evaluating human performance and system function; therefore it is an integral part of the hospital patient safety program, and has been in use for more than a decade. The hospital uses simulation to identify and remediate human and system weaknesses; the training has had the effect of transforming the culture at the children’s hospital away from one of blame and shame into one where staff acknowledge mistakes and learn from them. Real world outcomes of the program include:
- Creation of a hospital committee to identify and prioritize targets for simulation
- Empowerment of multidisciplinary task forces to implement simulation
- Re-allocation of resources from less effective training and safety efforts to simulation-based programs
- Collaboration with professional organizations to create national models of care
DISCUSS:
- Where has your hospital used simulation to teach and/or transform care?
- What did you learn from simulation that you didn't anticipate at the outset?
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