Simulation center uses real-world training

Findings inform hospital quality program

A futuristic training center where hospital staff and medical students alike can treat realistic mannequins for a wide range of conditions is the first step toward what its proponents hope will be a regional center serving patient safety professionals from many different facilities.

The facility is part of The University of Miami/ Jackson Memorial Hospital Center for Patient Safety in Miami.

"Our mission is education, research, and clinical quality improvement," says Paul Barach, MD, MPH, director of the center, associate dean for the University of Miami School of Medicine and director of quality efforts at Jackson Memorial Hospital. "It goes to the concept of building a training arm in addition to our quality improvement arm," he explains.

The center, Barach adds, is "tightly integrated with Jackson Memorial."

For about 18 months, the center has used an old operating room to train trainees and nurses on the mannequins in a variety of clinical interventions — from small procedures such as placing IV lines, to resuscitation and crisis management. But Jan. 13 saw the grand opening of a new 8,000 sq. ft. facility for multiple uses — medical/surgical, obstetrical, trauma, acute care, and so on.

"This will give people the ability to train in a realistic setting without harm to the patient or provider, and the ability to turn it into an educational experience," he notes.

In the new center are several full-sized mannequins programmed to react to different scenarios, and treated either by an individual or by a full team of providers. The sessions are recorded for future debriefings. "They can also be stored, so the trainee can revisit them later on," Barach adds.

Providing nontraditional instruction

The traditional approach to learning in medicine, according to Barach, has been the "see one, do one" approach. But this is not how many other professionals learn.

"In the sports environment, you have an opportunity to review the videos of your performance, but we have not really had that in health care," he asserts.

The mannequins, which are made by several different manufacturers, range from body parts to whole bodies and are quite realistic, Barach notes.

"They can be programmed with a variety of scenarios. They have electrodes, which allow you to feel pulse arterial pressure; you can put a foley catheter in or place an intravenous line into the great veins of the neck," he points out.

These mannequins provide what engineers call "user haptic feedback," or resistance from the tissue. "If you put a needle in the skin, the tissue has give — it allows you to better replicate true interaction," Barach adds.

In a trauma case, the trainee might work through typical patient characteristics, and then the patient might go into cardiac arrest or ventricular fibrillation. "It’s very interactive," he explains, even to the point where the patient can crash.

"It mimics what aviation does by crashing the plane in simulations; we crash the mannequin," Barach says.

"The goal is not to overwhelm them but to see what happens when they overdo. So, for example, if we want to understand what happens when things do not go well, we might pursue it to flat line, take that video, go in the briefing room, and discuss what the trainer or team could have done to prevent things from going that far," Barach notes.

The trainees, he points out, range from high school and college students to med school nurses and residents, to faculty.

"All of the simulations are programmed around a learning objective that is part of the larger curriculum we have created for the students," Barach explains.

The goal also is to train in coordination with the organization’s objectives, such as meeting standards set by bodies such as the Joint Com-mission on Accreditation of Healthcare Organizations and the National Quality Forum, he continues.

You can create scenarios with specific learning in mind, he adds. "For example, if we want to better understand why falls happen, we can create an environment with a bed and a patient falling out of bed, and try understand how best the nurse could interact to prevent that," Barach offers.

Not just any hospital could support such a program, he cautions. "The issue is more than just the mannequins; it’s the atmosphere that supports it," Barach notes, putting the estimated cost at somewhere between $500,000 and $800,000 a year.

"I envision us as having regional training centers [across the country], where people can come and train periodically," he says.

In addition, however, many facilities would have the ability to purchase an individual mannequin for about $20,000 to $40,000.

"I imagine that once a year, they could come to a very large center and hook up with their environment, then replicate the scenario with their own mannequin at their hospital," Barach offers. "Or there could be web-based communication using streaming video; we’re just starting to explore those ideas."

Finally, he notes, the center will have the ability to translate what it learns into meaningful lessons to be published. After all, "It’s incumbent upon us to share what we learn."

Need More Information?

For more information, contact:

• Paul Barach, MD, MPH, Director, Center for Patient Safety, University of Miami School of Medicine, Jackson Memorial Hospital, 1611 N.W. 12th Ave., North Wing 109, Miami, FL 33136. Phone: (305) 585-8364. Fax: (305) 585-8359. E-mail: