By Marci Foster
When Mrs. Dow was taken back to her room after surgery, all signs suggested she would recover well and without incident. However, as her physical therapist was assisting her with getting out of bed the next morning, she complained of shortness of breath. Mrs. Dow was placed back in bed so her team could examine her and figure out what was causing the issue. Her vital signs showed that her blood pressure had decreased significantly, and her pulse had increased. Moments later, Mrs. Dow’s breathing increased dramatically. Her nurse quickly activated the Rapid Response team, a group of healthcare providers that responds to patients on non-intensive care units with early signs of respiratory or cardiac arrest. During the evaluation, Mrs. Dow stopped breathing, and the team couldn’t find a pulse. Jumping into action, the nurse initiated a Code Blue, which alerts a highly specialized medical team to help when a patient experiences a cardiac arrest.
This is a real-life, stressful situation that could happen while a patient is recovering from surgery. But today, where the scenario unfolds in a clinical simulation and training lab, it is just for practice.
When scenarios such as Mrs. Dow’s are created in the lab, it provides an entire clinical team – from nurses, physicians, and respiratory therapists, to cardio pulmonary specialists, anesthesiologists, and pharmacy technicians—with the opportunity to practice their skills and focus on ways to work together more effectively and efficiently. Studies show that when used in conjunction with classroom instruction and clinical experiences, care providers trained in simulation labs are more efficient, more confident, and better analytical thinkers. These hands-on trainings also lead to improved patient outcomes and higher rates of treatment success.
“Clinical simulations are an important part of reinforcing knowledge, improving teamwork and communication, and streamlining processes,” said Karyn Book, associate chief nursing officer at Penn Medicine Princeton Medical Center (PMC), “It’s an opportunity for our team to practice clinical skills in exactly the same environment where they’ll be providing care.”
Penn Medicine has a long and proud history as a leader in medical education, both for future care providers and those in practice today. Penn Medicine’s simulation lab in Philadelphia has been in operation since 2008. There, simulation courses teach a range of skills from proper cardiac resuscitation techniques for clinicians to how to deal with difficult personnel issues and coaching for managers.
“Most people are initially nervous but then find that the course is one of the best they’ve taken,” Ann Mokris, course facilitator, said of the performance improvement course. “We allow them to apply what they’ve learned in a safe way … and then use it back in their offices.”
Penn’s newest Simulation and Training Lab at PMC is scheduled to open in 2020. The 1,760-square-foot Simulation and Training Lab will be constructed on the first floor of the medical center and will include a full-size mock patient room and two classrooms – one with a patient bed and headwall. The lab will be designed for hands-on and training as well as remote, off-site call-ins, providing an opportunity for the hospital to take education and training to the next level.
Using two highly sophisticated patient simulators – an adult female and an infant – healthcare professionals from all disciplines, including medical students, will be able to hone their skills. In the lab, simulated sessions will range from the practice of individual technical skills such as placement of IV lines, to more complex, collaborative interprofessional treatment scenarios such as delivering a baby or a cardiac arrest.
Simulation specialists running the show behind the scenes use a sophisticated control panel to adjust the patient simulator’s symptoms and responses, creating a range of standard medical and surgical issues. For obstetrics & gynecology training, for example, the simulator can be used to train care providers in managing high-risk deliveries – such as an emergency c-section – and post-partum care emergencies like a uterine hemorrhage.
The simulator of a premature baby behaves similar to a newborn, including crying and making grunting sounds. She also interacts with a range of tools, creating life-like scenarios, such as neonatal resuscitation, where the simulator “responds” to treatment through adjustments in breathing or heart rate.
Simulations practiced in the lab can mimic some of the worst-case scenarios that clinicians may encounter on any given day. Being able to host risk-free, real-life trainings in the same environment in which patient care is delivered will help to ensure that clinicians have the skills and confidence to care for patients — whatever situation may arise.
The creation of the Simulation and Training Lab at PMC was the result of gifts from several donors to the Penn Medicine Princeton Medical Center Foundation, including lead donor Betty Wold Johnson. The adult female simulator was purchased through the George and Estelle Sands Foundation Fund for Cardiac and Pulmonary Care. The neonate simulator, from a grant supported by Mr. and Mrs. Jack Z. Rabinowitz.