Training with mannequins improves safety, efficiency
Training with mannequins improves safety, efficiency
Responses to treatment closely mirror life
A growing number of ED physicians and managers are gaining access to a training resource that its proponents claim boosts patient safety, improves training efficiency, and ensures a higher level of skills retention: lifelike mannequins that simulate real-world patients and case scenarios.
The mannequins uncannily mirror what ED physicians face on a daily basis, says Paul Barach, MD, MPH, director of The University of Miami/Jackson Memorial Hospital Center for Patient Safety in Miami.
They can be programmed with a variety of scenarios, Barach says. "They have tubes, cavities, and electrodes that allow you to feel pulse arterial pressure," he says. "You can put a Foley catheter in or place an intravenous line into the great veins of the neck."
In a trauma case, the trainee might work through typical patient characteristics, and then the patient might go into cardiac arrest or ventricular fibrillation, Barach says. It’s interactive, even to the point of having a patient "crash," he explains.
The Miami center, which opened 18 months ago, is one of the newer such facilities in the United States. This January saw the opening of a new 8,000-square-foot facility for multiple uses, including medical/surgical, obstetrical, trauma, and acute care. ED residents have just begun training there.
Practicing low-volume procedures
One of the pioneer facilities in the country is the Peter M. Winter Institute for Simulation, Education, and Research (WISER) at the University of Pittsburgh, which has been in its current location for 18 months but was founded in 1994. The training has been extremely beneficial for the ED at the University of Pittsburgh Medical Center (UPMC), says Paul Phrampus, MD, FACEP, who spearheads the training at WISER that is specific to emergency medicine physicians.
"It has increased the levels of patient safety and increased the level of training efficiency," observes Phrampus, who is an assistant professor of emergency medicine in the UPMC department of emergency medicine and assistant director of WISER. "You get a lot more bang for the buck in terms of hours of training, and you have the ability for people to experience low-volume, high-acuity situations and repeat them over and over again."
WISER uses SimMAN mannequins from Laerdal Medical, based in Stavanger, Norway, almost exclusively, says Phrampus (Barach says he uses mannequins from several manufacturers).
"We can use them for pure teaching, to show physiologic changes in response to trainee intervention, like giving meds or performing a procedure," he says. "If a medication error occurs, the mannequin would respond to the wrong med in an adverse way — for example, it might have an allergic reaction — and the trainee would be expected to correct it." Trainees at WISER include medical students, nursing students, resident physicians, paramedics, emergency medical technicians, and active faculty.
They also use the mannequins for competency assessment and testing, Phrampus says. "We put the trainee in a specific situation and make sure they manage it like they would a real patient, and make sure they meet the expected best treatment guidelines, to ensure higher levels of patient safety and error reduction."
The Miami facility just had its first ED session a few weeks ago. "So far, we have three case scenarios: allergic reaction, asthma, and chest pain," says Andrew Ta, MD, FACEP, associate medical director at Jackson Memorial’s Emergency Care Center. "We also plan to review ACLS [advanced cardiac life support] protocols with residents."
Ta says he has worked with the mannequins, and they are very lifelike. "Vital signs can change, breath sounds can change, you can intubate the patient — pretty much everything you would do on a live patient," he says.
Abdul M. Memon, MD, FACP, FRCP(C), FACEP, chief of emergency services and medical director at the Emergency Care Center, sees significant patient safety implications for the mannequins. "You could take [the Joint Commission on Accreditation of Healthcare Organizations’] national patient safety goals and design specific simulations to assess whether each one is being followed," he suggests.
Access for EDs increasing
The cost of establishing centers such as the ones in Miami and Pittsburgh make it impractical for every hospital or ED (Barach estimates the cost of running such a facility at somewhere between $500,000 and $800,000 a year), but that doesn’t mean EDs can’t benefit from this technology.
First, he notes, a single mannequin can be purchased for about $20,000 to $40,000. Beyond that, centers like his make arrangements for outside organizations to send trainees. The center offers a range of courses that cost from $750 to $2,000 per person, depending on course duration (the longest course is a full two days), level of matriculation, and instruction.
As for UPMC, Phrampus reports that he is planning to offer the course to outside doctors, but the center is just getting ready to begin to roll the course out to all of the community affiliate docs first. "After that, we are going to offer public courses," he says.
In addition, a new Pittsburgh-based spin-off company named SimMedical is exporting the technology to other places to develop their own simulation education efforts.
A growing number of ED physicians and managers are gaining access to a training resource that its proponents claim boosts patient safety, improves training efficiency, and ensures a higher level of skills retention: lifelike mannequins that simulate real-world patients and case scenarios.Subscribe Now for Access
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