It’s your first week of residency at a world-renowned children’s hospital. There are twenty minutes left on your shift and you will have made it through without a major event. You are about to breathe a sigh of relief when you hear a page overhead -3F Room 17- STAT – Code Blue. Your heart stops, you break into a cold sweat as you realize that this isn’t a practice run, this is the real thing. Someone’s life is hanging in the balance and it is your job to save them. What’s even scarier – it’s a child – and his or her life is in your hands.
The high fidelity simulator program at McMaster Children’s Hospital (MCH) is a life-saving educational tool that prepares physicians and health-care professionals – new and seasoned – for this exact moment.
McMaster Children’s Hospital in Hamilton is home to the only training program of this kind in Ontario and one of very few in Canada and indeed, around the world. The two key missions of the program are education and patient safety. In order to meet its mission, MCH has brought simulation from the classroom into the clinical setting and trained a multidisciplinary team of instructors.
The two simulators, PediaSim ECS and BabySim at MCH, are modeled after a real seven-year-old boy and a six-month old infant. The simulators breathe, blink, have heart sounds and pulses. More importantly, the sophisticated computer software within the simulator allows it to interact and change depending on the actions of the medical team. ICU monitors can be attached to the simulators, just as they would be to a real child or infant, to display vital signs such as blood pressure and heart rhythms. The simulators can also be programmed to replicate any situation a real child could experience.
Doctors, nurses, respiratory therapists and medical students are able to simulate a variety of clinical scenarios, from an infant with a cold to a child with multiple injuries, to a child having a cardiac arrest from an unknown cause. The health-care team is able to make crucial medical decisions and practice life-saving techniques such as cardiopulmonary resuscitation over and over again without the possibility of making an error on a real patient. At McMaster Children’s Hospital, simulations have taken place in classrooms, clinics, wards and ICU’s.
“These simulators play an important role in helping our doctors and nurses provide the best care possible for our children,” says Dr. Lennox Huang, Deputy Chief of Pediatrics at McMaster Children’s Hospital and Medical Director for the simulator program. “Continual training and practice are essential to patient safety and ensuring excellence in our clinical practice. It is also radically different from the traditional ‘see one, do one, teach one’ model of medical education.
The simulators have great benefits to educational, clinical and patient safety outcomes. “The simulator program is extremely important because any potential scenario can be recreated, from an allergic reaction to a cardiac arrest,” said Dianne Norman, a pediatric critical care nurse who is now MCH’s clinical outreach specialist.”We can even have physicians practice putting in chest tubes and we can actually have a blood-like substance come out of the wounds.”
Situations that occur less commonly in children, such as cardiopulmonary arrest or a traumatic injury are often more complex and difficult to treat than similar ailments in the adults. Since most experienced health-care professionals will only occasionally deal with such cases, human patient simulators enable the health-care team to realistically reproduce unusual events to gain more experience.
Research shows that the higher the critical mass of particular cases, the better the outcomes, and there is growing evidence that high fidelity simulation is an effective way of exposing a higher volume of patient cases to medical professionals.
“Not long ago we had a situation where we had a group of trainees work through a mock code using the simulator. The pediatric residents were able to make their mistakes in the simulation and receive immediate feedback.” said Dr. Huang. “Coincidentally, later that day we experienced a very similar event in our Pediatric Critical Care Unit (PCCU) and were able to implement the same skills that we had learned during simulation into this situation and ultimately had a positive outcome.”
The simulators also help learners experience a more life-like experience than in past training modules. And although the high-fidelity simulators look artificial, the real life reactions trigger real responses from trainees. “You can see it in their eyes. You can see the moment when they realize that if they don’t do something, if they don’t do the right things for this patient, there could be some serious consequences,” said Dr. Huang. “In the past we would train with plastic dummies that required a great deal of imagination on the part of the learner and the instructor and now we have this innovative new program and tools that brings the mock codes to life.”
The pediatric simulator training also plays an essential role in ensuring the systems and supports are appropriate and all measures are in place to facilitate the best response possible.
“Although we may have excellent resuscitation skills, we also need to examine our system for potential areas of improvement,” said Dianne Norman. “For example, do we have the right equipment, do we have it in the right place, do the doors fit our stretchers? There are some things that you don’t actually find out until you go through a mock scenario.”
Simulated scenarios also provide staff with an opportunity to apply MCH’s family-centred care philosophy, which encourages families and caregivers to be participants in their child’s care, to critical care situations.
“Even during our simulations we continue to practice family-centred care,” said Dr. Rob Lloyd, Medical Director of the PICU. “Our learners and staff automatically ask for parents and incorporate them in the scenario – whether it’s something as simple as giving intravenous fluids or more acute such as performing CPR on a patient with a cardiac arrest. We are also committed to sharing this philosophy with our peers and partners in the community.”
In keeping with that, many physicians and nurses at MCH are simulation instructors. This has allowed MCH to greatly expand the program and offer outreach to the surrounding community hospitals. The goal of the outreach program is to engage other hospitals by offering them the tools and training they need to take care of kids before they reach a tertiary level pediatric centre.
As the only pediatric centre in Ontario with high-fidelity simulation, MCH will host a training course for pediatric critical care response teams from hospitals from across the province in January 2007 in collaboration with the other pediatric academic health sciences centres in Ontario and the Canadian Resuscitation Institute (CRI). For more information please contact Dianne Norman, Clinical Outreach Specialist at 905-521-2100 x73998 or firstname.lastname@example.org.