ED simulation made 'real' with use of actors

'Patients' help staff prepare for move

As the ED staff at Valley Medical Center in Renton, WA, was preparing to move into its new "digs," emergency services manager Kayett Asuquo, RN, BSN, MBA, CES, recognized that it was important that they do more than just take a walking tour of the new facilities. They needed to see how it would function as an environment for treating patients.

In fact, a simulation involving the treatment of several types of "patients" was part of the master plan a year before move-in, Asuquo says. This simulation, however, had an added element of realism: The patients were played by professional actors, who the hospital contacted through the local playhouse. None of the actors were paid for the simulation.

"My goal was that it would really be a valued-added experience for the staff," says Asuquo. "We had 40 different scenarios, from childbirth to out of control 'psych' patients." The scenarios were developed by a clinical nurse specialist, an ED physician, a staff nurse, and a charge nurse, and reviewed by the staff education committee, she says. "We wanted the staff to feel very involved and invested in the process," Asuquo explains.

The simulation took place over eight days, because 150 staff members were involved. "The groups were no larger than 10 to 15 people," says Asuquo. The participants were not on ED duty during the simulation, so the remaining staff kept the real ED running smoothly.

Prior to the actual simulation the staff participants gathered together with leadership and went over the ground rules. "We talked about the importance of them being invested, and they took it seriously," says Asuquo.

The simulation ran for about two hours and included ambulance patients and walk-ins. It was followed by a 30-minute debriefing aimed at discussing what did and did not work.

Acting made simulation seem real

Asuquo was amazed at how realistic the simulations were. "I was observing to make sure everyone felt comfortable in the space, and one 'pregnant' lady came in screaming. I thought she was going to drop the baby on the spot," she recalls. "They take pride in their craft, and they were very real."

The actors stayed in character the entire time, adds chief nursing officer Scott Alleman, RN, MSN. "If you're an educator for the ED and you do role playing, you're likely to jump out of character if the staff member gets stuck," he notes. "The whole idea is to discover things we didn't anticipate or that might be a problem, and you won't do that unless you play the scene out, which was ensured by using real actors."

Asuquo says she helped ensure a smooth simulation by introducing the staff to the new technologies they'd be using well in advance of the drill. This included new IV pumps, computerized physician order entry (CPOE), and other computer tracking and management systems.

The reaction of the staff, was very positive, she says. "Some even wanted to do it again," Asuquo says. She was so pleased, in fact, that she recommends that ED managers consider using actors for other types of simulations, such as disaster drills. "I would recommend it because of that level of realness," she says. "You can get local drama clubs or high school kids, so it does not have to cost you money."

Sources

For more information about using actors for ED simulations, contact:

  • Kayett Asuquo, RN, BSN, MBA, CES, Emergency Services Manager, Valley Medical Center, Renton, WA. Phone: (425) 228-3440. Ext. 8188.
  • Scott Alleman, RN, MSN, Chief Nursing Officer, Valley Medical Center. Phone: (425) 656-5517.

Environment, not skill subject of simulation

When Kayett Asuquo, RN, BSN, MBA, CES, emergency services manager at Valley Medical Center in Renton, WA, organized a simulation complete with acting professionals to help prepare for a move to a brand new ED, it was not her staff she was looking to put to the test. It was the new environment itself.

"We believe we have excellent clinicians. Our RNs are required to have all the major ENA certifications," Asuquo says. "Our purpose was not to test clinical skills, but to learn the new environment and how to integrate the new processes and equipment we had been using in the old space into the new space."

Several lessons were learned, she says. For example, in the simulation there were six cardiac arrests being treated at same time, but the staff realized they could have slowed things down a bit. "They learned it was not as important to worry about how fast they got to the cath lab as to know how to get to it," Asuquo says.

The simulation also showed members of the charge nurse group they couldn't practice the same way they did in the old space. "One of my zones today is as big as the old ED," Asuquo says. "In the old days if you had a chest pain patient, you could yell [down the hall] for help. Now you have to rely more on technology."

Chief nursing officer Scott Alleman, RN, MSN, says, "Most of the discoveries were relatively minor, but useful. So, for example, we did not find out we weren't prepared for cardiac monitoring, but we may have found out the location of some supplies was not optimal, or the way we thought people would use the paging system was not as convenient as we anticipated."

All in all, says Asuquo, the move-in has gone smoothly, and the simulations "helped tremendously." "Some people I thought would not do well in the new space have done remarkably well," she says. "The staff has been amazing."