Practice makes perfect: The use of simulation in Trauma Outreach Program

The Children’s Hospital of Eastern Ontario (CHEO), provides outstanding family-centered patient care, pioneers breakthrough research, and trains future health care professionals. As a tertiary level pediatric hospital we are fully cognizant that children and youth can be prone to injuries.

Thankfully, through the use of effective injury prevention initiatives and patient education campaigns, we strive to greatly reduce these occurrences. Unfortunately, injuries do happen.

That is when our trauma team comes in. This multidisciplinary team of professionals treats approximately 70 major traumas in a given year. They are therefore well-versed in the physiological and anatomical needs of children and youth, and have the latest child-adapted technology at their disposal. Staying on top of evolving best practices in pediatric trauma care is a necessity for them.

But for many regional hospitals, the situation is different.

“Regional hospitals have to treat the entire gamut of trauma cases that present at their emergency department – from infants to teenagers and adults to the geriatric population – and they often see the worst of them,” explains Dale Dalgleish, a clinical nurse educator for CHEO’s Simulation Program.  “We have tremendous respect for the work done at regional hospitals. They provide exceptional care and it is our goal to help enhance their practice.”

In 2000, the hospital was designated as a Lead Pediatric Trauma Centre for Eastern Ontario by the Ministry of Health and Long Term Care. To better fulfill their mandate of education and outreach to hospitals within the Champlain Local Integration Health Network (LHIN), Dr. Steve Noseworthy, Trauma Director at CHEO, and his team decided to take their Trauma Simulation Program on the road in 2010.

“Our mission is to empower regional ED staff, and to promote best practices and knowledge exchange,” explains Dr. Noseworthy. “Better patient care means better odds for pediatric trauma victims. So by using a hands-on approach, combined with interactive techniques and modern technologies, we teach essential cognitive and behavioural skills in both simulated environments, here at CHEO and in situ  in regional hospitals within the Champlain LIHN. This ensures that every single child and youth receives state-of-the-art trauma care, wherever they are treated.”

In essence, the program helps to provide an increased awareness of advances in pediatric trauma care, and related considerations for a pediatric population.
CHEO’s Simulation Program uses state-of-the art, full-sized, computerized pediatric patient mannequins – or simulators – to provide both individual and team training. In fact, participation of the entire team is highly encouraged – everyone gets into the action, including a member of CHEO’s trauma team that acts as the grieving, panic-stricken parent that trauma teams are bound to encounter after a code is activated.

“I play the worried parent,” explains Helen Yoxon, CHEO’s trauma coordinator. “With an adult population, the team can easily focus on the trauma patient, but when you’re dealing with children and youth, most often you will have the added task of managing an anxious parent and you must communicate with that parent at the same time that you are caring for their child. So when we simulate trauma codes, we make it as lifelike as can be.”

And that includes using mannequins that eerily mimic human functioning, including having a heartbeat, wheezing, and moving their eyes. Health care workers then jump to action to assess, diagnose, and manage the trauma case, before sitting down for a private debriefing session afterwards to review how things were handled and what lessons were learned, before they’re off to another round of simulated codes.

“We know that our peers in regional hospitals have the heart, the passion, and the skills needed – our hope is to provide them with the additional tools and tricks of the trade that hopefully will make a positive impact for the pediatric trauma cases they’ll encounter. All those little things can make the difference between good patient outcomes and stellar ones,” adds Dr. Noseworthy.
And the team enjoys organizing simulation sessions and running various exercises on site at local regional hospitals. There, the drills or exercises serve to identify and address any barriers to optimal care for the local trauma staff.

They are taught to use the equipment they have at their disposal and adapt it to meet the needs of infants’ or children’s physiological and developmental needs.
The CHEO Trauma Outreach Simulation Program has received great feedback from regional hospitals who have taken part in their simulation exercises, All the kudos received keep fuelling the team’s passion for optimal care and information-sharing.

This passion for continuing education, increasing the odds of best outcome possible and optimal patient care are traits that CHEO shares with the regional hospitals of Eastern Ontario; and it is what makes this region such a wonderful place to raise a family.