The Providence simulation program trains health care workers on everything from intubation to holding the hand of a patient near death
October 31, 2014
Enter the control center of Providence Little Company of Mary Medical Center’s Torrance-based simulation lab, and you might just think you’ve walked onto the set of Grey’s Anatomy. There are high-tech hospital beds, IVs, an electrocardiographic heart monitor and (fake) blood, bodily fluids and medications. There’s even a food tray with a forlorn piece of French toast and a glass of milk.
Alas, however, there’s no Dr. McDreamy. But there is the $85,000 Laerdal SimMan 3G. SimMan is an eerily believable mannequin patient.
“He blinks, he sweats, he cries. He has a heart rate and blood pressure. We can even program him to have a seizure or a stroke,” says Heidi Traxler, RN, MSN, nurse educator and the clinical simulation program manager.
So what’s the point of all this? The state-of-the-art lab, as well as a similar one at Providence Little Company of Mary Medical Center San Pedro, runs training exercises for Providence health care teams four days a week. The lab was launched in 2008 as a collaboration between Providence Health & Services, Providence Little Company of Mary Medical Center Torrance and El Camino College nursing school.
UniHealth Foundation, a Los Angeles-based foundation that supports innovative health activities, awarded Providence Southern California South Bay Service Area a $1 million grant to support the simulation program for RNs and nursing assistants with a focus on quality and safety. Because the program was such a success, UniHealth then granted another $1 million in 2011 to expand inter-professional training with nurses, doctors and other medical professionals already working at Providence clinics and hospitals.
“I think we’ve been able to get this support because the simulation program has such a clear and vital purpose: to ultimately improve the safety and outcomes of all Providence patients,” says Ellen Gorbunoff, director of education and professional development.
The training sessions consist of no-nonsense drills dealing with real-life medical crises. Roughly 13 Providence doctors and nurses, trained as faculty, take turns sitting behind glass, much like television producers, as embedded cameras and audio record every move.
A scenario, developed by Traxler and colleagues, is presented to a team of medical professionals who then manage the complex clinical situation using effective communication and team skills. The scenario is carried out as real-to-life as possible.
Whoever would normally be in the hospital in the given scenario is present: nurses, doctors, respiratory therapists, anesthesiologists, surgeons, medical technicians and others. There are even volunteer actors who pose as family members or the patients themselves.
“Sometimes it gets really intense,” says Traxler. “It is so real. We could be dealing with a women’s health issue, a neonatal, gastrointestinal or intensive care scenario, but the atmosphere, whether we are doing simulation in the sim lab or in the actual patient care area, is always as if you were in the hospital and the medical emergency was truly happening.”
IVs are inserted. There’s intubation, hemorrhaging and resuscitation. In some cases, doctors even have end-of-life conversations with “family members.” This gives them the opportunity to work on their patient and family communication skills.
The sim program is also used to train volunteers for Providence’s No One Dies Alone program. “We use simulation to train them to sit with people who are dying and may not have friends or family members around,” says Gorbunoff. “Volunteers have to know how best to respond to people at end-of-life stages. So we work on scenarios that help them recognize signs of pain or anxiety. We train the volunteers on how to best comfort the patient and when to get the attention of a nurse for help.”
After each training scenario, a debriefing session is held, and the team gets to review the recordings and discuss where they excelled and where there were gaps. The actor-family members are asked to give feedback to the medical team about how information was communicated to them.
“It’s pretty phenomenal. The atmosphere is as high-pressure as in a real scenario, but even veteran doctors love to come here. It just gives our health care teams a unique opportunity to evaluate the clinical scenario, teamwork and communications and see where they could be improved, with the goal of our teams being able to provide the highest quality and safest care possible should that scenario occur with a patient in the hospital,” says Traxler.
And, of course, SimMan is an incredibly forgiving patient. “With a little clean-up, he’s quickly ready to have the next medical emergency,” says Gorbunoff. “So we practice on him and save the perfection for our real patients.”