PURSUING ZERO CLINICAL SIMULATION
2010 ANNUAL REPORT 1
Copyright © 2010 by MedStar Health’s SiTEL. All rights reserved. Publisher: Clinical Simulation Team
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“When the mission is patient first, you don’t practice first on the patient.” Yuri Millo, MD, Medical Director
VISION Looking back, 2010 was a year of remarkable growth in our simulation program development, national leadership, designing, and defining the business of clinical simulation. This year, we were awarded the Brandon Hall Bronze Award for Blended Learning, as well as The Healing Spirit Award. SiTEL’s Clinical Simulation Center (CSC) emerged as a leader and a center of Excellence, supporting a diversified population of healthcare providers across educational domains. SiTEL’s CSC’s mission is to improve patient safety and clinical outcomes by integrating clinical simulation based teaching methodologies into the training curriculum for all healthcare professionals.
SiTEL’s CSCs utilizes a learning environment to create experiential education. Through the integration of medical simulation and traditional medical training, we reinforce best practices and patient safety mental models, while striving to keep medical errors at an absolute minimum. SiTEL’s CSCs responds to patient safety concerns by teaching medical procedures using real life, immersive simulations. In immersive and interactive learning environments, medical professionals gain valuable experience in a realistic environment, learning with patient simulators instead of real patients. Citing its success in the aviation industry, the Institute of Healthcare Im-
provement (IHI) reports that simulation helps prepare people for error-prone, high-risk, or unusual situations. For healthcare educators, striking a balance between an enriching educational environment and an exceptional patient care facility can be difficult. Our simulation training methodology, however, is attempting to do just that-- remove patients from the training equation. Simulation provides a controlled environment for healthcare professionals to learn their craft, starting with the most essential skills and progressing toward complex team training scenarios. Our training programs employ simulators to teach technical, cognitive, and behavioral skills. “There is an old saying that ”practice makes perfect.” In reality, practice makes behavior more or less permanent. Perfection can only be achieved through deliberate Practice (practice with feedback). Through practice (simulation) and feedback (debriefing), learners have the best opportunity for reaching that perfection”. (Erikson, 2008) 3
CLINICAL SIMULATION GOALS GOAL ONE
0
Improve teamwork by providing a safe environment for critical events team training.
GOAL TWO Promote excellence in performance of psychomotor skills in related field(s) of practice.
GOAL THREE Support proven teaching methodologies that enhance safe practice and improve clinical reasoning.
GOAL FOUR
GOAL FIVE Provide resources that help employees attain professional competencies and standards.
PURSUING ZERO
Create a learning environment that fosters development of assessment, communication, psychomotor, critical and creative thinking, inquiry, and problem solving skills in relation to a variety of simulation activities.
GOAL SIX Support applied simulation research.
“Observe, record, tabulate,
GOAL SEVEN
communicate. Use your
Promote simulation training as a discipline in healthcare.
five senses. Learn to see,
GOAL EIGHT
Support usability groups who are researching new devices and procedures to ensure pertinence, accuracy, and safety, and to provide an intuitive user interface.
learn to hear, learn to feel, learn to smell, and know that by practice alone you can become expert.� William Osler
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“SYSTEMNESS” KEN SAMET, CEO OF MEDSTAR HEALTH
“I’d like to build on the work that’s already been done in several areas. One particular area I like to call “system-ness.” We need to take better advantage of all the components of MedStar. We do great things in this system, but we don’t necessarily do the same things every day in every place.”
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INSTANCES OF MEDICAL HARM OCCURING EVERY DAY IN THE UNITED STATES
FORTY THOUSAND What Is Medical Harm? Medical harm is defined as unintended physical injury resulting from or contributed to by medical care including the absence of indicated medical treatment, that requires additional monitoring, treatment or hospitalization, or that results in death.
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INSTANCES OF MEDICAL HARM EACH YEAR
MILLION
OUR GOAL
$17 0 PREVENTABLE MEDICAL HARM COSTS
HELP MEDSTAR HEALTH ACHIEVE ZERO
BILLION
6
OUR NATIONʼS ACTIVE PHYSICIANS
YEARS TO TRAIN A PHYSCIAN
800,000 10 5,000,000 11 BILLION 2020 NURSES AND NURSING AIDS
ANNUAL HOURS WORKED
SHORTAGE OF 200,000 PHYSICIANS AND 1,000,000 NURSES
FORTY SEVEN PERCENT RECALLED A CASE WHERE A PATIENT DIED
PHYSICIANS AND NURSES WILL HAVE TO LEARN MORE FASTER ADDITIONAL INFORMATION FROM ELECTRONIC RECORDS
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TABLE OF CONTENTS Programs
10-13
SiTEL’s Clinical Simulation provides tailored education and training courses under four distinct divisions.
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Growth
14-15
Growth can be defined by many measures: maturity, size, number, value, or strength. Our simulation programs have increase or improved in all these areas.
Design
16-17
By embracing the “long view,” we understand how to design experiential learning spaces that can be used for highly immersive simulation training and to evaluate new training solutions.
ADVANCE
ENGAGE
LEAD
CHAMPION
CONTRIBUTE
SiTEL is a leader in a close network of simulation professionals whose shared mission is to advance the field of healthcare simulation and patient safety.
INVENT
18-19
Acknowledgements
42 44 46
INSPIRE
Presentations
30 32 34 36 40 IMPACT
OUR STORIES
Awards/Accreditations
20-23 24-27 In 2010, we are honored to recognize a select group of professionals we call “Champions,” and “Contributors.”
This year, we are pleased to announce two awards, as well as our accreditations. We strive to serve our MedStar Health community, as well as the greater community around us.
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“You don’t have an airline pilot fly a plane without being in a simulator at some point, so that’s what we’re doing. If you can practice in a safe environment first, you’re better off,”
PROGRAMS SiTEL’s Clinical Simulation Program is designed to provide tailored education and training courses under four training domains: Team Training, Psychomotor Skill Acquisition, Communication, and Clinical Reasoning.
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SiTEL’s CSC courses reach all healthcare professionals (physicians, nurses, allied healthcare, and students), across the spectrum of learning and professional development, including high school, graduate education, residency, and fellowships to specialized providers. SiTEL offers discipline-specific programs that integrate core competencies and customized courses that support
established program curricula. Leveled course work throughout each program allows for the development of deliberate practice, using evidence-based education methodologies and evaluation measurements. While each program focuses on specific learners, the diversity of healthcare participants in SiTEL’s CSC has cultivated a rich, collaborative, inter-professional environment. Program Highlight ORL Bootcamp, July 2010 Eighteen faculty members from major ORL programs in New Jersey, Phila-
Dr. Malloy
delphia, Baltimore, and Washington, DC participated in the first ORL Bootcamp event for SiTEL. The ENT Emergencies Bootcamp is the brainchild of Dr. Sonya Malekzadeh of Georgetown University Hospital, Dr. Ellen Deutsch of Children’s Hospital of Pennsylvania, and Dr. Kelly Malloy of University of Pennsylvania. These three Otorhinolaryngology (ORL) specialists joined forces with SITEL to execute a one-day, hands-on simulation training event for ORL residents. The Bootcamp was held at SiTEL’s Clinical Simulation Center (CSC) in Washington, D.C.
PROGRAM DESIGN
A HOLISTIC APPROACH
HOW HEALTH PROFESSIONALS OF THE FUTURE WILL LEARN Our approach to designing each of our programs and their courses is informed by learning theories and is increasingly grounded in evidence-based practices.
8%
2010 CLINICAL SIMULATION PROGRAMS CSC Simulation Programs
54% CLINICAL REASONING
COMMUNICATION SKILLS
CRT- Critical Response Training/Resuscitation Programs MeS- MedSTAR Trauma Physician Services EM- Emergency Medicine IM- Internal Medicine GS- General Surgery OB/GYN- Obstetrics and Gynecology ORL-Otorhinolaryngology PED- Pediatric PMR-Physical Medicine and Rehab ANS- Anesthesia Allied Health SPC- Spiritual Care PCT- Patient Care Technicians PHARM- Pharmacy
13%
PSYCHOMOTOR SKILLS
25% TEAM TRAINING
Nursing Services NP- Nurse Practioners NR- Nursing Residency SRN- Staff Nurses STU- Student Nurses
SIMULATION LEARNING THEORIES Constructivism Experiential Learning Adult Learning Theory Novice to Expert Continuum Brain-based Learning Social Cognitive Theory
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GREATER WASHINGTON D.C. BALTIMORE REGION
COMPARATIVE VOLUME OF ORGANIZATIONAL TRAINING
HARBOR HOSPITAL FRANKLIN SQUARE HOSPITAL CENTER MONTGOMERY GENTERAL HOSPITAL GOOD SAMARITAN HOSPITAL UNION MEMORIAL HOSPITAL ST. MARYʼS HOSPITAL
WASHINGTON HOSPITAL CENTER
UNION MEMORIAL HOSPITAL
48.1 %
1.8 %
NATIONAL REHABILITATION HOSPITAL
1.2 %
HARBOR HOSPITAL
15.4 %
GOOD SAMARITAN HOSPITAL
4.5 % GEORGETOWN UNIVERSITY HOSPITAL WASHINGTON HOSPITAL CENTER NATIONAL REHABILITATION HOSPITAL
GEORGETOWN UNIVERSITY HOSPITAL
25.9 %
FRANKLIN SQUARE HOSPITAL CENTER
3.0 %
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PROFESSIONALS TRAINED AT EACH ORGANIZATION
Allied Health
TOTAL STAFF
SIMULATION TRAINED
1432
1518
1280
490
52 430
861
387
250 51
67%
42%
7%
62
28
5%
46%
16%
568
306
NATIONAL REHABILITATION HOSPITAL
628
828
GOOD SAMARITAN HOSPITAL
733
1908
HARBOR HOSPITAL
1169
2139 UNION MEMORIAL HOSPITAL
1398
2532 FRANKLIN SQUARE HOSPITAL CENTER
72
1002
3885
Allied Health Clinicians (Physicians, Residents, Medical Students and Nurses)
GEORGETOWN UNIVERSITY HOSPITAL
WASHINGTON HOSPITAL CENTER
2560
HOSPITAL FULLTIME STAFF
Clinicial Staff
1258 1248
874
31
10%
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GROWTH offerings increased in all programs during the 2010 training year. For example, our emergency medicine program grew by twelve courses to support all years of the graduate medical education program.
Growth can be defined by many measures: maturity, size, number, value, or strength. Across the board, our simulation programs have improved or increased in these. Expansion of courses offered at our centers is driven by either the needs identified by faculty or by the learners themselves.
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One of the greatest accomplishments of an education center is to close the gap on unmet training needs. SiTEL course
We completed training for 186 courses this year, increasing our total volume of participants to 11,517. Remarkably, we conducted over 46,000 hours of training. We continue to increase the scope of our training course. Our AHA and Professional Development course offerings round out our spectrum of simulation training programs. Our program offerings continue to grow across the disciplines of Nursing, GME-General Surgery, Internal Medicine, Emergency Medicine, OB/GYN, Physical Medicine and Rehab, ORL, Pediatrics, and Anesthesia. Other disciplines we offer courses for include: Attending Physicians, Nurse Practitioners, Physicians Assistants, Spiritual Care, Allied Health, and Medical and Nursing Students.
CLINICAL SIMULATION GROWTH
Participants Centers Courses Hours
4
32%
NUMBER OF CENTERS
11,500 Participants
7900 Participants
TOTAL COURSES OFFERED
100
o
180
OVER
100
2009
2010
OVER
HOURS TAUGHT
42,500
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sign elements in the simulation center that can be easily moved or adjusted. Adaptability is the most desired form of flexibility from an operational viewpoint. This refers to the capability of making operational changes without construction.
DESIGN By embracing the ”long view,” we understand how to design spaces that can be used for highly immersive simulation training, as well as evaluating new training solutions.
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The user experience is everything. When you walk into a classroom, office, or simulation center, while it may seem obvious to many, it all starts with the user experience. The physical environment impacts how we learn. The challenge faced with designing new simulation training environments is to create a space that can be rapidly transformed, allowing frequent transitions across diverse training needs.
The need for new learning environments in healthcare can be brought to life through simulation training centers. We create environments that continuously respond to emerging technologies to ensure future compatibility of the space with new uses, methods, and technologies. Traditional simulation center designs place priority on shortterm flexibility‚ demanding immediate adaptability‚ while innovative thought toward multiple designs offers longerterm flexibility for easier operational change. Adaptability is key. Our goal is to provide our simulation center staff with de-
The simulation center’s modular design supports multiple technologies that combine to create an exceptionally experiential environment that can support a variety of learning objectives. The space is designed to train healthcare professionals and students in the domains of skills acquisition, clinical reasoning, communication, and team training. This technology is used to define spaces rather than having permanent, immovable walls define a space. Organization of the interior space is easily tailored so it is a more effective use of space. This allows for multiple uses throughout the lifetime of the built environment. Simulation Centers must be resourceful; they must balancing functional, fiscal, and pedagogical needs. Intelligent, innovative designs for spatial configuration, functionality, and creativity can provide the flexibility needed for adaptable learning spaces. They also must take into consideration the evolving learning styles and preferences among students, emerging pedagogies, and physical characteristics driving the design of effective learning spaces.
SIMULATION CENTER DESIGN FOR HEALTHCARE’S FUTURE Designed in collaboration with
CONNECTING THE BUILT ENVIRONMENT WITH THE HUMAN PSYCHE
When Christopher Alexander wrote A Pattern Language more than 25 years ago, he looked at the real world of people, as well as the buildings and spaces they inhabited, in order to understand the connections between the built environment and the human psyche. Today, we know that our brains are hardwired to understand and respond to patterns
that exist within our built environments. If we are to have a school where students become healthcare professionals, we need to provide them with an environment that supports the realms of human experience: spatial, psychological, physiological, and behavioral. 17
PRESENTATIONS In November 2009, the CSC/MOST team presented at the Perinatal Collaborative Conference. The presentation was on the use of high fidelity simulation in the Perinatal setting.
SiTEL strives to share its mission to advance the field of healthcare simulation and patient safety. Our faculty has quickly reached a national presence as experts in teaching and integrating simulation into healthcare education.
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In December 2010, the SiTEL CSC team presented a four-hour, pre-conference workshop for the Emergency Cardiovascular Care Update (ECCU) conference in San Diego, CA. The participants had the opportunity to use the deliberate practice model to aid in instructing sessions for a series of AHA cases, including BLS, ACLS, and PALS. A variety of simulation modalities were used for the AHA cases, from low to high fidelity simulators.
In May 2009, SiTEL’s CSC team led two sessions for Laerdal’s Simulation User Network (SUN) Meeting in Baltimore, MD. These sessions were titled “360 Degrees of Simulation: Designing Successful Simulation” and “Simulation: A Bridge to Patient Safety.” The SiTEL CSC team also launched the second day of the conference with the keynote lecture and followed with a live demonstration of a case study using the newly released SimMan 3G.
In June of 2010, SiTEL participated in the Kaiser Permanente National Healthcare Simulation Collaborative. Pamela Leonard presented “How to Fund and Sustain a Simulation Program.” The Collaborative was initiated to organize efforts to provide all eight KP regions with robust simulation programs in a variety of ways in order to reduce adverse events.
Integrating of the Clinical Simulation Center in Hospital Operations. Pamela Leonard. Paper presented at the 14th Annual Multidisciplinary CME ConferenceControversies in Medicine: A Forum for the Exploration and Discussion of Current Issues in Medicine in Mexico, February 2009. Teaching Flight Medicine without Patients...Are We There Yet? Pamela Leonard. Paper presented at the Critical Care Transport Medicine Conference in San Antonio, TX, April 2009. Auguste, TC, Boswick, JA, Loyd, MK, Battista, A. The simulation of an ex utero intrapartum procedure to extracorporeal membrane oxygenation. Journal of Pediatric Surgery, 2011 Feb; 46(2): 395-8. High Fidelity Simulation: Scenario Presentation of Shoulder Dystocia with Neonatal Resuscitation. Belinda Clifford, Tamika Auguste, and MOST Team. Presented at the Perinatal Collaborative Conference at The Gathering Place, Howard County, MD, November 17, 2009. Simulation in Gynecologic Surgical Education. Yuri Millo, MD; Christopher Awtrey, MD; Andreas Meier, MD; Dee Fenner, MD; and J. Eric Jelovsek, MD. Panel Presentation at the Society of Gynecological Surgeons’ and the American College of Surgeons’ Annual Scientific Meeting, Tucson, AZ, April 12, 2010. ORL Emergencies Boot Camp: Onboarding Residents with Simulation, Instruction Course. Sonya Malekzadeh MD, Kelly Malloy MD, and Ellen Deutsch, MD. Presented at the AAO/HNS Annual Meeting, Boston, MA, September 2010. Novel Education Model for Post-Operative Respiratory Distress. J. Aidan Boswick, BA and Laura S. Johnson, MD. Poster Presentation presented at the 2nd Annual International Conference on Surgical Education and Training (ICOSET), Dublin, Ireland, May 2010. MedStar Safety Rounds. Tamika Auguste. Poster Presentation presented at the MOST-MedStar Obstetrical
Safety Training, Columbia, MD, March 2009. Hands on Obstetrical Simulation Course. Tamika Auguste and Alexis Batista. Presented at the American College of Obstetricians and Gynecologists’ Annual Clinical Meeting, Chicago, IL, May 2009. Blended Learning for the Remediation of an OB/ GYN Resident. Tamika Auguste. Poster Presentation presented at the Association of Professors of Gynecology and Obstetrics’ Annual Clinical Meeting, Orlando, FL, May 2010. The Push for Safety: ‘Once Is Not Enough’—Simulation in Team Learning. Tamika Auguste. Presented at the Midwest Nurse Educator’s Academy, Grand Forks, ND, May 2010. Hands on Obstetrical Simulation Course. Tamika Auguste and Belinda Clifford. Presented at the American College of Obstetricians and Gynecologists’ Annual Clinical Meeting, San Francisco, CA, May 2010. Safety Measures in Womens’ and Infant Services. Tamika Auguste, WIS Leadership. Presented to the Risk Management Board of Directors at Washington Hospital Center, Washington, D.C., December 15, 2010. Simulation Enhanced Procedural Training For Emergency Medicine Intern Orientation: A First Step. Reed KR, Ross TM, Wood S, Chang E, Milzman D. Oral abstract presented at Western Regional SAEM Meeting in Keystone Colorado, February 24, 2011.
of Simulation Training of Rare but Critical Procedures for Emergency Medicine Residents. Reed KR, Ross TM, Wood S, Neuner M, Milzman D. Oral session abstract presented SAEM Annual Meeting, Phoenix, AZ, June 6th, 2010. High-Risk Obstetric Delivery Scenarios: Benefits f Simulation Training of Rare but Critical Procedures. Ross TM, Reed KR, Wood S, Neuner M, Milzman D. Poster presented at AAEM/JEM Resident Research Competition at the AAEM Scientific Assembly, Las Vegas , NV, February 15, 2010. Temporary Transvenous Pacing: Simulation Benefits of a Rare Procedure. Reed KR, Wood S. Simulation workshop presented at the Medical Education and Simulation Conference at HPSN 10 (Human Patient Simulation Network) in Tampa Florida, March 3rd, 2010. Teaching and Maintaining Competency for Rarely Performed Critical Procedures Through Simulation. Ross TM, Desai S, Reed, KR, Bhat R, , Goyal M, Milzman D. Poster abstract presented at the US Critical Illness and Injury Trials Group at the National Institutes of Health, Bethesda, MD, December 9, 2009 Temporary Transvenous Pacing: Simulation Benefits Instruction of Critical but Rare Procedure. Reed KC, Wood S, Bhat R, Milzman DP. Poster abstract presented SAEM Annual Meeting, New Orleans, May 14th, 2009.
Cranial Trephination: Simulation Model for Emergency Medicine Resident Training of a Rare but Life-Saving Procedure. Kevin Reed, Dave Milzman, Sangeeta Wood, Rahul Bhat, Ryan Gerecht. . Poster presented at ACEP Research Forum at ACEP Scientific Assembly, Las Vegas , NV, September 29, 2010. High-Risk Obstetric Delivery Scenarios: Benefits
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ACKNOWLEDGEMENTS In 2010, we are honored to recognize a select group of professionals we call “Champions” and “Contributors.” Literally, a champion is someone who takes it upon himself or herself to move a cause forward, to drive change, to become the standard by which others are measured. Our Champions are tireless in their efforts to promote the continual adoption of clinical simulation across MedStar Health.
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“Most look up and admire the stars. A champion climbs a mountain and grabs one.” Unknown
2010 CLINICAL SIMULATION CHAMPIONS Sangeeta Wood, MD Director of Emergency Medicine Simulation Program Emergency Medicine Attending Physician SiTEL, MedStar Health
Tamika Auguste, MD Director of OB/GYN Simulation Program Assistant Professor of Obstetrics and Gynecology SiTEL, MedStar Health
Jeffrey Dubin, MD, MBA Medical Director, AHA Training Program Assistant Professor of Clinical Emergency Medicine Vice Chair of the Department of Emergency Medicine SiTEL, MedStar Health
Sonya Malekzadeh, MD, FACS Director of ORL Simulation Program Associate Professor of Otolaryngology Head and Neck Surgery SiTEL, MedStar Health
Burton Lee, MD, FCCP Director of Pulmonary Critical Care Simulation Program Fellowship Program Director Assistant Professor of Medicine SiTEL, MedStar Health
Jack Sava, MD, FACS Director of General Surgery Simulation Program Director of Trauma Associate Program Director of General Surgery SiTEL, MedStar Health
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2010 CLINICAL SIMULATION CONTRIBUTORS Debbie Biewer, RN, BSN Clinical Educator, Department of Ambulatory Care , Franklin Square Hospital
Evelyn Egizi, RN, MSA Anesthesiologist, Department of Anesthesiology Washington Hospital Center
Cynthia M. Blackett, RN, MSN, ENPC Education Specialist, Emergency Department Good Samaritan Hospital
Heather Everly, RN Flight Base Manager, MedStar Transport, Washington Hospital Center
Crystal Benjamin-Jackson, MD Anesthesiologist, Department of Anesthesiology Georgetown University Hospital
Abbie Fields, MD Gynecologist/Oncologist, Women’s and Infant’s Services, Washington Hospital Center
Eugene Campian, MD Urogynecologist, Department of Obstetrics and Gynecology, Franklin Square Hospital
Daisy Fischer, MSN, RN, CPAN Education Specialist, Critical Care Department Good Samaritan Hospital
Robert Dobbin Chow, MD Program Director, IM Residency Program Good Samaritan Hospital
Steve Friedman Manager, Department of Respiratory Therapy Harbor Hospital
Rebecca Coleman, RN, BSN Orientation Specialist, Emergency Department Franklin Square Hospital
Carolyn Hanny-Gilbert, RN Ventricular Assist Device Coordinator, Washington Hospital Center
Jonathon Cosin, MD Director and Gynecologic Oncologist, Gynecologic Oncology Department, Washington Hospital Center
Lauren Gordon, MD Director of Women’s Health, Department of Family Medicine, Franklin Square Hospital
Donovan Dietrick, MD Program Director, Obstetrics and Gynecology Residency Program, Franklin Square Hospital
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Debra Rovito, BSN, RN, CPN, CPEN Education Specialist, Department of Pediatrics Franklin Square Hospital
Raymond DiPhillips, MD, FCCP Physician, Department of Surgery, Washington Hospital Center
Rob Gutman, MD Gynecologist/Obstetrician, Department of Obstetrics and Gynecology, Washington Hospital Center
Rita Driggers, MD Director, Maternal-Fetal Medicine Fellowship Program, Washington Hospital Center
Gabriel Hauser, MD, FAAP, FCCM, FACCP Director, Pediatric Intensive Care Unit Georgetown University Hospital
Roseanne Dunkle, RN, MS, CCRN Nursing Educator, Critical Care Department Washington Hospital Center
Beverly Howe, RN Education Specialist, Perioperative Services Harbor Hospital
Cheryl Iglesia, MD Director of Female Pelvic Medicine and Reconstructive Surgery, Department of Urogynocology, Washington Hospital Center Tammi Johnson, RN Nurse Educator, Department of Nursing Washington Hospital Center Melissa Kath, MD General Surgery Chief Resident, Department of Surgery, Washington Hospital Center Kathy Lavery, ACNP-BC, MSN, NP Nurse Practitioner, Washington Hospital Center Veronica Gomez-Lobo, MD Gynecologist/Obstetrician, Department of Pediatric and Adolescent Gynecology, Washington Hospital Center Terri Mangini, RN, MSN SCN Nurse Manager, Neonatal Care Unit Harbor Hospital Tawney Manning Academic Dean, Vivian T. Thomas Medical Arts Academy Rene Mayo, MSW, MD Physician, Geriatric and Palliative Medicine Department, Union Memorial Hospital Patricia McCabe, RN, MSN, CCRN Director and Clinical Nurse Specialist, Rapid Response Department, Washington Hospital Center Edward McCaron, MD Assistant Program Director, General Surgery Residency Program, Union Memorial Hospital Karen Miga, RN, MSN Clinical Nurse Specialist Washington Hospital Center Karen Moriarty, RN, MSN, PCCN Stroke Program Coordinator, Critical Care Department, Washington Hospital Center Margaret Montgomery, CNM, MS
Nurse Midwife, Department of Obstetrics and Gynecology, Washington Hospital Center Nilda Moreno-Ruiz, MD, MPH Director, Division of Family Planning and Prevention, Washington Hospital Center Jennifer Moy, ACNP-BC, BA, NP Nurse Practitioner, Department of Nursing Washington Hospital Center Peyton Neilson, MS, RN, OCN Nurse Manager, Inpatient Oncology Franklin Square Hospital Micheal Niehoff, MD Director of Musculoskeletal Programs, Department of Family Medicine, Franklin Square Hospital Ndidi Nwokorie, MD Pediatric Attending, Department of Pediatrics Franklin Square Hospital Amy Park, MD Urogynecologist, Department of Obstetrics and Gynecology, Washington Hospital Center
Sherry Reisler, RN, BSN Education Specialist, Department of Medical and Surgical Services, Harbor Hospital Catherine Reisenberg, Ph.D, FNP-BC WHC Program Director, Georgetown University Scholars, Washington Hospital Center Robert Renix, BA, MDIV Chaplain and ACPE Supervisory Candidate, Department of Spiritual Care, Washington Hospital Center
Andrew Sokol, MD Associate Director of Minimally Invasive Surgery, Department of Urogynecology Washington Hospital Center Debbie Svoboda, RN, BSN Orientation Specialist, Department of Pediatrics Franklin Square Hospital Marie Turner, RN, BSN Nurse Educator, Perioperative Services Washington Hospital Center
Susan Rogers Residency Coordinator, Department of Medicine Franklin Square Hospital
Russell Wall, MD Director of Anesthesia, Department of Anesthesiology, Georgetown University Hospital
Nicole Roskowski Nurse Educator, Washington Hospital Center
Kathryn Walker, PharmD, BCPS, CPE Clinical Pharmacist, Department of Palliative Care, Union Memorial Hospital
Dina Rosenthal, RN, MSN, CCRN Clinical Nursing Instructor, Georgetown University Scholars Program, Washington Hospital Center
Briana Walton, MD Director, Women’s Center for Pelvic Health Anne Arundel Medical Center
Claribel Sawyer, RN, MSN Clinical Instructor, School of Nursing and Health Studies, Georgetown University Hospital
Clara Warner, RNC, MSN, PCM South 6 Manager, Department of Medical and Surgical Services, Harbor Hospital
Suna Seo, MD Chief Resident, Department of Pediatrics Georgetown University Hospital
Daniel Perlin Anesthesiologist, Department of Anesthesiology Washington Hospital Center
Kathy Wharton, RN, MSN Clinical Nurse Specialist, Department of Emergency Services, Franklin Square Hospital
Debbie Senesi, RN, MS Nurse Educator, Washington Hospital Center
John Perkins, MD Associate Program Director, Internal Medicine Residency Program, Franklin Square Hospital
Kim Shanahan, MS, RN Clinical Nurse Specialist, Professional Practice and Research, Franklin Square Hospital
Richard Williams, MD Director, Internal Medicine Residency Program Harbor Hospital
Karen Perkins, MD Director, Family Medicine Maternal-Child Health Curriculum, Franklin Square Hospital
Jakki Showel Nurse Educator, Washington Hospital Center
Sara Parker, MD Staff Physician, Department of Obstetrics and Gynecology, Washington Hospital Center
Geri Petit, BSN, CRNP Nurse Education Specialist, Neonatal Intensive Care Unit, Franklin Square Hospital Miya Purvis, RN, BSN Clinical Instructor, School of Nursing and Health Studies, Georgetown University Hospital
Brooke Shuster, MD Resident, Department of Pediatrics Washington Hospital Center Doug Snyder, MD Associate Chairman and Operating Room Medical Director, Department of Anesthesiology Washington Hospital Center
Cheryl Wood, RN, MSN Manager, Neonatal Intensive Care Unit Franklin Square Hospital Chrisian Woods, MD Physician, Department of Internal Medicine Washington Hospital Center Alex Eskander Yazaji, MD Director, Internal Medicine Residency Program Union Memorial Hospital
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AWARDS/ACCREDITATIONS “Excellence is an art won by training. We do not act rightly because we have virtue or excellence, but we rather have those because This year, we are pleased to announce two awards, as well as our accreditations. We strive to serve both our MedStar community and the greater community around us. Our goal is to provide unparalleled education and training and to inform our community about our educational practices. There is no better way to spread the word than to be recognized for an achievement. We are very grateful for this recognition. 24
Our simulation centers are accredited as Level One education institutes by the American College of Surgeons. We are also an OB/GYN Simulation Consortium Center. And, as a testing center for Fundamentals of Laparoscopic Surgery, we provide specialized training designed for surgical residents, fellows, and practicing surgeons. Finally, our CSCs are part of the American Heart Association training centers, teaching CPR and Advanced Life Support.
we have acted rightly. We are what we repeatedly do. Excellence, then, is not an act but a habit.� Aristotle
BRANDON HALL AWARD BRONZE AWARD FOR BLENDED LEARNING
HEALING SPIRIT AWARD In November 2010, SiTEL’s Clinical Simulation Center was honored to receive the 2010 Healing Spirit Award. This award is to honor those individuals who, in the course of daily care for patients, promote spiritual care as a part of the healing process, support the work of the department of Spiritual Care, and incorporate the presence of chaplains as a vital part of interdisciplinary teams.
The Brandon Hall Excellence in Technology Awards program recognizes the many technological advances made each year by solution providers in commercially-available tools and technologies for learning, talent management, sales, and marketing. The Blended Learning Award recognizes design excellence across use of pedagogy and technologies, and meeting learners’ needs. In 2010, MedStar’s Obstetrical Safety Training (MOST) Program received this award to recognize our blended learning curriculum. This course focuses on teams who need to complete a set of tasks in rapid order in an effort to save an obstetrical patient’s or neonate’s life. The course trains obstetricians, anesthesiologists, neonatologists, nurses, and others to work together to deliver patient care in emergent situations. Participants complete pre-course materials on SiTEL’s Learning Management System, participate in a live, simulated training program with facilitated debriefing, followed by online post-course assessments. 25
In 2009, SiTEL of MedStar Health became a member of the American College of Obstetricians and Gynecologists Consortium. The American College of Obstetricians and Gynecologists (ACOG) formed a Consortium of stateof-the-art surgical simulation centers, with the goal of providing voluntary access to standardized and validated surgical curricula (which simulate OB and GYN surgical procedures) within easy geographic reach for all OB/GYN residents in the United States and beyond.
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SiTEL received testing status from SAGES in March of 2009. The mission of FLS is to provide surgical residents and practicing surgeons with an opportunity to learn the fundamentals of laparoscopic surgery in a consistent, scientifically accepted format and to provide a tool to test cognitive, clinical, and technical skills, with the overarching goal of improving the quality of patient care. The FLS program teaches residents and surgeons the physiology, instrumentation, and technical skills involved in performing basic laparoscopic surgery. In addition, the FLS assessment component measures a candidate’s cognitive knowledge, case/problem management skills, and physical dexterity.
SiTEL is an authorized American Heart association Training Center providing emergency life support classes. We support the mission of the American Heart Association Emergency Cardiovascular Care Program to build healthier lives, free of cardiovascular diseases and stroke, by improving the Chain of Survival in every community. We offer Basic Life Support for Healthcare Providers, Advanced Cardiovascular Life Support, and Pediatric Advanced Life Support. We incorporate AHA outcome data into all of our resuscitation courses, resulting in an expansive Code Blue curriculum.
SiTEL received Level One Accreditation I in June of 2009. The vision of the ACS Accredited Education Institutes is to create a network of ACS-approved regional Education Institutes that offer practicing surgeons, surgical residents, medical students, and members of the surgical team a spectrum of educational opportunities, including education that addresses acquisition and maintenance of skills and focuses on new procedures and emerging technologies. The goal of the ACS Accredited Education Institutes is to focus on competencies and to teach, learn, and assess technical skills using state-of-the-art educational methods and cutting-edge technology. 27
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ENGAGE
CHAMPION
LEAD CONTRIBUTE
ADVANCE
INSPIRE
INVENT
IMPACT
OUR STORIES
ADVANCE | FIELD SIM CENTER
ENGAGE | FRANKLIN SQUARE
LEAD | MOST
CHAMPION | CAPITAL SHIELD
CONTRIBUTE | RX FOR SUCCESS
INVENT | THYROID SIMULATION
INSPIRE | DOCTOR FOR A DAY
IMPACT | CODE BLUE
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Sing Along. Start A Heart “
C CC
“ “
Call for Help
3
C
CA
Turn On Defibrilator
2.
B
“
1.
CC
“
Circulation Airway Breath
“
“
Check
1“ 2
“
Care
C AB “
Analyze Defibrilator
“1 2 “ 3
3. Shock as Indicated
IMPACT | CODE BLUE Code teams are well established in healthcare environments. Traditionally, team’s members hone their skills by completing ACLS and BLS certification courses. Still, a gap in translation to practice was evident. In 2009, Code Blue committee leaders, along with SiTEL’s education team, developed the first of a series of Code Blue training courses.
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The desired outcomes of these courses were to reduce defibrillation times to meet the American Heart Association
goals, improve team performance at the bedside, and reduce system barriers. Empowering the staff and furthering the leadership skills of the team leader were a few of the improvements. Through hard work, collaboration, and dedication from the team over the course of four years, we have found that it takes more than one approach to address these pitfalls. The team has redesigned the Code Blue Programs to include five at the present time:
1. 2. 3. 4. 5.
START A HEART
MNEMONIC Matters of the heart. Every year since 1900, cardiovascular disease has accounted for more deaths than any other major cause of death in the United States. 90%
SURVIVAL RATE DECREASES WITH EVERY MINUTE
10 M
0%
80%
INS
INS
SUCCESS RATE PER PASSING MINUTE DEFIB MUST START BEFORE 5 MINUTES NATIONAL GOAL FOR PROFESSIONALS
2 M
AVERAGING ONE DEATH EVERY 10%
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70%
SECONDS
60%
20%
NUMBER OF AMERICANS WHO DIE OF CARDIOVASCULAR DISEASE
50%
30%
INS
5 M
2,730
40%
EACH DAY
Sing Along. Start A Heart “
C CC
“ “
Call for Help
3
C
CA
Turn On Defibrilator
2.
B
“
1.
CC
“
Circulation Airway Breath
“
“
Check
1“ 2
“
Care
C AB “
Analyze Defibrilator
3. Shock as Indicated
“1 2 “ 3
Mock Code Blue In Situ Mini Mock Code Blue In Situ Code Blue Readiness Code Blue Challenge Resident Code Blue Refresher
The end result shows that we are getting closer to the American Heart Association goal of three minutes. During our drills, in Situ defibrillation times four years ago were at an average time of 10 minutes. Currently, In Situ defibrillation times are at an average time of four minutes. The team continues to strive towards reaching the AHA goal of three minutes. BLS recertification every two years is not enough. Research has shown that multiple reinforcements are needed to practice skills in between recertification in order to retain knowledge. Rapid response activation has decreased Code Blue rates, which emphasizes this point even further. Our unique debriefing approach has evolved into a very effective tool for reinforcing the BLS process. This approach includes self evaluation of the team, lessons learned, and reinforcement of the BLS primary survey using a mnemonic created by the SiTEL staff. The Code Blue responders’ feedback after the drill is largely positive and our team is frequently asked to return soon for another drill. The code blue responders have requested the mnemonic “CCC, CAB, 123” printed on posters throughout the healthcare environment as a reinforcement to the BLS process.
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Save a life
Become a
DOCTOR for a day
INSPIRE | DOCTOR FOR A DAY “SiTEL provides a unique experience to high school students. They can understand first-hand what it’s like to be a healthcare professional.” Pam Leonard, Director Clinical Simulation Centers, SiTEL, MedStar Health 32
During 2010, Harbor Hospital approached SiTEL to assist with fundraising for the Annual Water Ball Event. We immediately thought about the opportunity to offer the community a Doctor for a Day Simulation Program. At SiTEL’s Clinical Simulation Center Baltimore, the “Doctor for a Day” program offered high school students the opportunity to experience what it is like
to be a medical professional. During this course, students train in a hightech medical simulation environment. The Simulation and Training Environment Lab of MedStar Health expanded the outreach program so more people from the community can experience the education and training that real healthcare professionals experience.
Sisters Kristen and Lauren Johnson, aged 15 and 18 respectively, were the first recipients to participate in the program in June of 2010. Both girls expressed an interest in pursuing a healthcare career. The outcome: the teenagers said their experience at SiTEL reinforced their interest in becoming healthcare professionals.
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Illustration by Laura Cosner
INVENT | THYROID SIMULATION A low cost thyroid trainer to support training for an “Essentially –common procedure “was developed by co- inventors Erin Felger, M.D. and Aidan Boswick.
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The creative energy of simulation technologist Aidan Boswick and Dr. Erin Felger led to this low cost alternative to procedural training outside the operating room environment. The model creation was an uncomplicated process. It was easy to create multiple models. It was also extremely cost effective; each model cost less than $5 to make. This course has been integrated to the gen-
eral surgery simulation program across MedStar Health. Partial or total thyroidectomy is listed as an “Essential-Common” procedure according to the 2010-2011 SCORE curriculums. Given an environment of shortening work hours and decreasing case volume, attaining specific procedural competency in this procedure is
becoming increasingly challenging. Simulation is an obvious solution to this challenge, but there are no endocrine surgery simulators currently described in the literature or available commercially. The model was created using anatomical textbooks, 3D models, and intra-operative observation as examples. A variety of materials were used,
primarily model-grade silicone and latex. The model’s fidelity was matched to the learning objectives of the associated course (i.e. realism was only sought in the parts of the model that directly impacted elements of the procedure).
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RX FOR
SUCESS
CONTRIBUTE | RX FOR SUCCESS
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MedStar Health officials, in partnership with the Baltimore City Public School System (BCPSS), unveiled the Rx for Success program at the Vivien T. Thomas Medical Arts Academy in 2007. Part of a five-year commitment between MedStar Health and BCPSS, Rx for Success is the most comprehensive allied health program in the region aligning an intricate network of corporate and civic partners to benefit public education. For the 2007-2008 academic school year, 220 students from the Vivien T. Thomas
Medical Arts Academy were enrolled in the program. Rx for Success is designed to prepare students for collegiate studies and careers in health and science. For the first time, MedStar Health and BCPSS are showcasing the merits of the Rx for Success program, its initial success, and its potential for implementation in other city schools. “Health care is an exciting industry to be in. We need to expose young students, our future workforce, to all the
possibilities,� says Kenneth A. Samet, President and Chief Executive officer of MedStar Health. As the shortage of Maryland healthcare workers continues to grow, we feel compelled to act by bringing both corporate and community organizations together to reverse this alarming trend. An active community partner, MedStar Health has fostered a number of academic enrichment programs in the region. In its most ambitious program to date, MedStar Health created an academic oasis for young Baltimore City students at the Vivien T. Thomas Medical Arts Academy, the inaugural school to participate in Rx for Success. Created to present channels of access and opportunity for young people in lowincome, scholastically challenged Baltimore neighborhoods, Rx for Success has been a source of inspiration and a benchmark for success among students at Vivien T. Thomas Medical Arts Academy. Additionally, officials involved with the program are hopeful that its longterm benefits will address the critical shortage of qualified healthcare workers in the region by creating a pipeline of talented, skilled individuals. The Rx for Success program marries the conventional curriculum as designated by the Maryland State Department of Education with specialized coursework geared to the healthcare profession. 37
WHAT CAREER PATH WILL YOU CHOOSE?
HIGH SCHOOL UNDERGRADUATE GRADUATE PROFESSIONAL
38
HIGH SCHOOL UNDERGRADUATE GRADUATE PROFESSIONAL
Allied Health
Medical Technologist
Allied Health Professionals work in healthcare careers other than nursing or medicine that require some form of post-secondary education. They provide a range of diagnostic, technical, therapeutic, direct patient care, and support services. The roles of Allied Health professionals are critical to other healthcare professionals.
Medical technologists perform a variety of tasks, including everything from simple pre-marital blood tests to more complex tests to uncover diseases such as HIV/AIDS, diabetes, and cancer. The work completed by medical technologists directly impacts patients’ lives.
HOW WILL YOU STAND OUT?
HIGH SCHOOL UNDERGRADUATE GRADUATE PROFESSIONAL
Medical Researcher
Medical researchers compile and analyze information about diseases, drug interactions, and patient progress. They collect data, confer with doctors and patients, and report findings to hospital administrators and others. Some medical researchers perform only analytical functions, while others take blood or perform other medical procedures.
HIGH SCHOOL UNDERGRADUATE GRADUATE PROFESSIONAL
Surgeon
Surgeons are physicians who operate to repair injuries, correct deformities, prevent diseases, and generally improve the health of patients. General surgeons perform many kinds of operations. Others specialize in one type of operation or one system or area of the body. Neurosurgeons, for example, operate on the brain, spinal cord, and nervous system.
HIGH SCHOOL UNDERGRADUATE GRADUATE PROFESSIONAL
Nurse
Nurses offer curative, preventative, promotive, and rehabilitative healthcare for families, communities, and individuals. Nurses participate in activities such as supplying health guidance and counseling to patients, as well as the diagnosis, planning, and execution of nursing strategies. 39
CHAMPION | CAPITAL SHIELD EXCERCISE CAPITAL SHIELD Conducted by Joint Forces Headquarters National Capital Region and the Military District of Washington
40
On October 13th and 14th of 2010, SiTEL’s CSC team participated in a disaster drill conducted in the national capital region. The exercise was executed by the military’s Joint Force Headquarters in partnership with the Department of Defense and civil emergency responders, such as D.C. Fire and EMS. SiTEL played an integral role in bringing the causalities to life by deploying High
Fidelity Simulation to drill the team in ATLS skills. COL Coots (Hospital CDR) presented certificates to SiTEL. The overall exercise certificates were established by the Joint Task Force Capital Medical (JTFCAPMED) group and were also presented by the Hospital CDR, Admiral Mateczun (JTFCAPMED CDR).
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LEAD | MOST
42
MedStar’s Obstetrical Safety Training course (MOST) developed out of a combination of many very well established simulation training programs that focused on safe care for the obstetrical patient. Nearly twenty percent of pregnant women nationwide develop a complication near the end of their term. But because the most serious life-threatening complications are rare, hospital staff may have limited experience in handling them in a crisis. MOST aims at identifying potential errors before
they occur. By rehearsing low frequency, high-risk occurrences, practitioners are able to identify systems problems that can be eliminated before they occur. High-reliability teams recognize errors before they harm the patient. The MOST Training Program’s goal is to create a High Reliability Perinatal Unit in order to optimize maternal and neonatal safety and to reduce potential patient harm and organizational risk exposure. The course allows teams to focus on a
complete set of tasks in rapid order in an effort to save obstetrical patients’ or neonates’ lives. Obstetricians, anesthesiologists, neonatologists, nurses, and others work together to deliver patient care in emergent situations. Participants are challenged to work together to understand the rationale for team training and how it fits into a quality patient safety program. SiTEL deploys this program to every MedStar Health Hospital with obstetrical services.
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ENGAGE | FRANKLIN SQUARE THE DOMINO EFFECT
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The domino effect is a chain reaction that occurs when a small change causes a similar change nearby, which then will cause another small change. This metaphor provides the backdrop for the success of incorporating simulation training throughout the Franklin Square hospital system. True faculty collaboration provided the catalyst for the effect. In Dominos, the energy required to topple each domino is less than the energy transferred by each impact, so the chain is self-sustaining. In education and training, the energy is knowl-
edge. Knowledge from one simulation champion inspired another that led to many others. This is a classic story of paying it forward. Once they experienced the unique education delivered through simulation, it was hard to hold them back. Faculty throughout the institution shared success stories of how simulation education assisted them in achieving previously unmet education goals.
They continue to develop new courses to support all their healthcare professionals. One example is the development of the Certified Medical Assistant course. The goal is to offer a simulation course aimed at honing skills essential to this healthcare provider. Recognizing education excellence, Franklin Square also transitioned to SiTEL’s American Heart Association and Neonatal Resuscitation Providers courses for its employees, currently of-
fered on site and at the Baltimore CSC location.
PROGRAMS Family Practice CMA OB/GYN BLS PALS ACLS NRP ED Skills Code Blue Team Training MOST Internal Medicine
Nursing Pediatric Team Training
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ADVANCE | FIELD SIM CENTER
46
In February 2010, we launched the Field Sim Center, a deployable medical simulation training environment.
bined with advanced courseware running on a clinical simulation management system.
The Field Sim Center was toured by dozens of providers and staffs from around the National Capital Region on the grounds of Bethesda Naval Medical Center. Inside the Field Sim Center, the latest medical simulation technologies, mannequins, and task trainers are com-
Personnel can practice and master skills in an environment that safely allows for error as part of the learning process to expertise. From a control room that can be located anywhere in the world, trainers monitor and control the simulated patient’s clinical status.
FIELD SIM CENTER
20’ Operations Container
20’ Storage Container
Structure Training Shelter IRT inflatable shelter: 25’ X 36’ X 12.5’ Packed Dimensions: 5’ X 6’ X 5’ Snow Load: 10 lbs/sq. ft. Wind: 55 mph with 65 mph gusts Durability Tested: 50 up/downs Setup Time: 6 minutes/2 persons Pack-up Time: 20 minutes/4 persons Weight: 880 lbs Herman Miller modular tent solution Electrical, mechanical components 6 rooms separated by curtains Individual lighting scheme for each room
Storage Container Tables Chairs Simulators
Crash Carts Computers Support Equipment
Operations Container Control Room Packed Shelter Inflator Environment Control Room Generator Flooring Distribution Line
25’ X 36’ Training Shelter
System Medical Simulation Technologies High-Fidelity Simulation: Laerdal SimMan® 3G and stretchers Procedural Task Trainers: Blue Phantom and folding tables Procedural Simulation Platforms: SiTEL Learning Management System: SiTELMS Simulation Accessory Training Kits: SiTEL
Communication Technologies SiTEL IT Support SmartVUE cameras Projectors Ruggedized Mobile Network Ruggedized Laptops Digital Video Manager Satellite Communication Dish: Intelsat
Uses
Medical simulation training Outreach for indigenous groups Continuing education Stand-alone clinic Triage
Partners SiTEL Herman Miller IBM Laerdal IRT
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HARBOR HOSPITAL FRANKLIN SQUARE HOSPITAL CENTER MONTGOMERY GENTERAL HOSPITAL GOOD SAMARITAN HOSPITAL UNION MEMORIAL HOSPITAL ST. MARYʼS HOSPITAL
We have assembled one of the most unique teams in the nation to address one of our nations’ greatest unsolved challenges: training for high risk environments. A crossdisciplinary team of clinicians, including nurses and physicians, work together with computer scientists, game designers, human factors engineers, instructional designers, researchers, and educators. Together, we create innovative training and education solutions, which are built from Web 2.0 technologies, multimedia and simulation and game technologies.
www.sitel.org GEORGETOWN UNIVERSITY WASHINGTON HOSPITAL CENTER NATIONAL REHABILITATION HOSPITAL
Clinical Simulation
ANNUAL REGIONAL IMPACT 48
We are part of MedStar Health, a $3.8 billion, not-for-profit organization. As the largest health system in the greater Baltimore-Washington corridor, the MedStar Health network includes nine hospitals and 20 other health-related businesses. It is one of the region’s largest employers with more than 29,000 associates and 5,300 affiliated physicians.
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THE POWER OF IDEAS N
TIO A L U M I S L CLINICA
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