Friday, September 1, 2017

Education Profile: Healthcare Simulation week

PRACTICE MAKES PERFECT: Care teams during the simulation course

This profile is part of a series designed to highlight the importance and impact of the hospital’s teaching mission and the work of the MGH Executive Committee on Teaching & Education (ECOTE). 

In recognition of the inaugural National Healthcare Simulation Week Sept. 11-14, this profile features four employees focused on simulation teaching: Erik Clinton, MD, departmental simulation officer in Obstetrics/Gynecology; Maureen Hemingway, DNP, RN, CNOR, Nursing Practice specialist; Rebecca Minehart, MD, MSHPEd, Operating Room simulation officer in Anesthesia; and Elizabeth West, RNc, MSN, WHCNP, Nursing Practice specialist.

Describe your recent simulation course. Who was taught and what do you hope they learned?

This simulation program introduced a new team training curriculum for interprofessional education. The training course consisted of two separate scenarios. The first involved an emergency obstetrical postpartum hemorrhage, and the second involved an obstetrical patient admitted to the operating room following a multi-trauma motor vehicle accident. There were four sessions geared toward Obstetrical/Maternal Fetal teams, Anesthesia providers, the Trauma Surgical Service, Perioperative Nurses and Transfusion Medicine/Blood Bank Service.

Takeaways from the course included ideal clinical management, leadership and role clarity, barriers to effective communication, challenges related to the availability of providers, the coordination of patients’ care and emergency use of blood products and transfusion management for massive hemorrhage. -EC

What clinical problem were you trying to solve in this course and how does it improve patient quality and safety?

The goals of this program were to learn how decisions are made in cases involving maternal patients with emergency medical conditions and to positively affect patient care by improving teamwork behaviors among caregivers from a wide range of specialties. In the field of Obstetrics, as with many other patients throughout the hospital, the situational acuity can change rapidly. For patients being evaluated in a hospital setting, determining a plan of care may require communication and decision making between multiple providers and services in a very short time. Care providers not only have different attitudes in the way they approach a crisis, but also in the way they communicate. Differing patterns of communication and priorities in care can result in the loss of critical information needed for effective care. Some information may not be communicated effectively or is not perceived as intended by the recipient member of the health care team.

We used these simulation experiences to improve our processes for collaboration, coordination and communication during maternal crises. We hope that through improving team communication and educating a diverse team of care providers our care will become more effective and efficient, thus creating a safe and seamless experience for the patient. -RM

What was it like to work across professions to plan this course? What challenges did you overcome?

The faculty developed scenarios with the perspective that each member of the care team fulfills an important role in the care of the patient. As the team came together, there was an unspoken commitment to emulate the behaviors that we were discussing. Planning physicians and nurses listened respectfully to one another and incorporated differing perspectives into the experience. Truthfully, there were very few challenges as everyone came together with a commitment to create the best possible experience for participants. One challenge involved the educational team’s commitment to accuracy and to creating a safe and educational experience, while understanding the simulation may have limitations with what experiences can be safely and consistently recreated. -MH

Tell us about a magical teaching moment during the course or the debriefing.

We witnessed the repeated opportunities our participants had to engage with other caregivers during a period designed to encourage reflectivity. It is very special to witness caregivers who agree to put themselves into a vulnerable position in front of their colleagues in the name of patient care, which felt as a true testimony to the commitment of the simulation staff to create a safe learning environment. All the providers who participated have extremely busy schedules; it was renewing to see and feel their dedication to excellence in patient care and to hear them support their colleagues. One concept that was illuminated at the debriefing table is that simulation brings about a cultural turning point where a group can acknowledge that health care is a team sport and we all need to work together to bring the best to the patient. -EW

Do you have recommendations or lessons learned for other teams of educators? How could this be repeated or transferred to other areas of the hospital?

We have learned from our successes and our failures that a fundamental respect for our co-workers is at the center of all effective teamwork. Other teams planning these simulations should tailor their educational experiences to the learners, figure out what is important to each group and incorporate those concepts into the debriefing sessions. 

Transferring this to other areas of the hospital begins with a commitment from the patient care units and leadership. Next, trained debriefing experts are critical to educational and fulfilling simulation sessions. Enthusiastic participants enrich the experience for everyone. –EC

To nominate learners or educators – from any profession and any career stage – for future profiles, email Andrea Paciello, executive director of Teaching & Education, at apaciello@partners.org.



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