World Healthcare Focus on Patient Centered Care

Conference Reports

The Halldale Team have attended a number of medical conferences in varied locations during the past few months While each conference had a different theme/s, different program and different international speakers they were all ultimately focused on patient care and safety. Better patient care and safety is the banner theme for the transformation of health care. Transforming healthcare through education and training of healthcare professionals using simulation was discussed at each conference with evaluation, feedback, and standardization of curriculum, devices and procedures being key components. New technologies that enhance diagnostic capabilities and medical training were discussed and demonstrated. At each of the conferences patient care and safety was a priority.

Medical Technology, Training and Treatment, (MT3) Conference theme was Benchmarking Quality Care and Enhancing Patient Safety through Better Education and Training. Innovative solutions for healthcare education and training were provided by individual speakers, panelist and technology demonstrations. Dr. Daniel Kelly, Sanford-Burnham shared his research in diabetes, heart disease and cancer that will someday lead to earlier detection, mitigation and hopefully eradication. Dr. Mark Bowyer, stated that medical education will be transformed through the use of simulation and gave specific examples of how trauma training via simulation has and is being transformed. Dr. Robert Rush shared the militaries simulation based training centralization and standardization strategy which is being used in all military medical simulation centers. Dr. Howard Champion’s presentation on open surgical simulation technology using VR demonstrated another advance in trauma training. Robert Soto raised issues about research and evaluation of simulation and its effects on learning.

Dr. Dan Clinchot explained the steps taken and the principles used to revise the Ohio State Medical undergraduate curriculum and Angela TenBroeck and two of her high school students shared the rewards of early anatomy training for students. A distinguished panel of nurses led by Tom Doyle shared their experiences in simulation development in nurse education programs. Ruby Wesley Shadow, Valerie Howard, Sue Crockett and Major Chad Corliss discussed the role of simulation in their respective center‘s education programs and what they believe the future of simulation training will be. Dr Howard discussed the rapid growth of simulation technicians and how centers could not run without them and suggested that someone develop a “Leadership in Simulation Instruction and Management “ course and train the trainers for center directors who she says are nurses, doctors, not necessarily teachers.

Dr. Al Moloff’s panel focused on disaster management for combat and civilian casualty care and Dr. James Geiling shared his Haiti and Pentagon experiences and discussed the planning and preparation needed to confront a disaster situation.

Four medical simulation center directors shared how their centers were organized, the centers’ design, curriculum development, return on investment strategies and performance assessments. Dr John Armstrong stressed the importance of planning, curriculum design and development and how each step in the process needs to be verified and validated from core objectives, through attainment of knowledge and skills to patient outcomes. He stated that 10,000 iterations of deliberate practice makes and expert, therefore we need maintenance of certification and standardization of procedures; Dr. Don Combs shared Eastern Virginia’s ROI model for their simulation center and declared that for smaller medical schools that did not receive big research dollars collaboration was key to survival. They are setting up a National Center for Collaboration in Medical Modeling and Simulation; Dr. John Schaefer discussed his strategy and steps in developing MUSC’s statewide network of seven simulation centers and 20 affiliates across South Carolina. He said simulation is key to saving dollars, as an example, it cost $30 per minute to train in the OR and $65 an hour in a sim lab; Paul Pribaz outlined North western’s assessment criteria for clinical simulation and training. Through the use of their catheter related bloodstream infections simulation training they reduced infections from 3.2 per 1000 to 0.5 per thousand and prevented ten incidents at a savings of $82K per incident.

Dr. Richard Satava’s Medical Technology panel included Dr. Eric Allely, Dr Ben Bodeker and Dr. Christopher Basciano. Dr. Satava, a simulation pioneer, stressed standardization and the fact that to proceed we must make errors. With simulation errors can be made and lessons learned without harm. He talked about the development of surgical simulation standards(ASSET) and the development of a fundamental robotics curriculum(FRS) that are being developed with membership of all key stakeholders; Dr Eric Allely, a trauma surgeon, said the greatest need is in chronic care. There are approximately 5000 lab test that a medic/doctor could order and that there is no way to interpret all the data received. They have developed a system to provide expert interpretation of complex lab data and it is being tested in five major hospitals across the US; Dr. Ben Boedeker demonstrated live intubation training conducted at a Spanish army military site in Madrid and taught to an MT3 conference attendee.

John Qualter, BioDigital, David Hadden, Thera Sim, and Ed Sims, Vcom3D showcased advancements in gaming technology for healthcare. Dr. David Metcalf demonstrated I-phone training capabilities and stated that future use will be phenomenal since the US has 100 per cent coverage?

L-R Major Corliss, Ruby Wesley Shadow, Sue Crockett, Valerie Howard and Tom Doyle, discussed simulation in nursing. Image Credit: Terri Bernhardt.

National Patient Safety Foundation 14th Patient Safety Congress had four plenary sessions: Engaging Patients: A Simulation; Was it Really a Miracle on the Hudson?; The Patient Safety Culture Proposition; and The Lucien Leap Town Hall.

Engaging patients was a skit sponsored by Kaiser, put on by doctors and nurses, Haru Okuda playing the harassed emergency room physician, the young patient (dummy) mother (a nurse) and an emergency room nurse from Kaiser assisting. The interactive experience demonstrated how to help patients be more involved with their own or their family’s healthcare, in particular learning about the possibility of misdiagnosis. (Dr. Okuda mis-diagnosed the young man’s symptoms because the mother told him he had seen a certain pediatrician. Dr. Okuda trusted the pediatrician, knew he was an excellent doctor and because he was getting phone calls, had a patient crashing did not get all the facts. The mother accepted his diagnosis. The skit was replayed with the mother being much more insistent about symptoms and the child never being this listless or missing school and the proper diagnosis was made. By using a simulation vignette and audience participation attendees experienced firsthand how simulations can be used to teach new concepts.

Was it Really a Miracle on the Hudson? In the plenary session Jeff Skiles the first officer on US Airways Flight 1549 when it made an emergency landing in the Hudson River offered insights as to why the famous incident was not a miracle, but the result of years of culture change and safety advancements in aviation. Skiles and Rollin J. (Terry) Fairbanks, MD, MS, an emergency physician, human factors engineer/safety scientist, and a private pilot discussed safety from the perspective of the aviation industry and the health care environment. Terry said it was hard to prepare teams for codes in hospitals because you didn’t know the other team members. Skiles said he had never met, nor flown with “Sully” until that flight. He stressed that each knew exactly what they had to do, had split seconds to do but were so well trained that it came naturally. He talked about how the airline industry reached standardization in training and why it was so important. Fairbanks said as a pilot and doctor the same systems approach and standardization could and should be used in healthcare and he talked about central line as an example. He said checklist were being used in OR’s . Skiles talked about near miss reporting and how crucial it was in the airline industry and Fairbanks felt that would be more difficult in healthcare because of malpractice, etc. They both agreed a number of lessons learned in aviation could be used very successfully in healthcare,

The Patient Safety Culture Proposition presented by David Marx, chief executive officer, Outcome Engenuity, LLC, introduced attendees to key concepts about our ability to collectively produce better outcomes and the five skills:

1.Values and Expectations, 2.System Design, 3 Behavioral choices, 4. Learning systems and 5. Justice and accountability needed to produce those outcomes. He related each to a hospital incident and how it could be handled.

Lucian Leape Town Hall was a roundtable discussion led by an NPSF executive, Leape and representatives from the Department of Health and Human Services and the Center for Medicare and Medicaid Innovation. Attendees were asked to identify new approaches, innovations and methods to create and sustain improvements in culture, process, and outcomes by sharing their experience and what they were doing in their hospitals, schools or medical clinics.

The conference breakout sessions covered six themes: Embracing the Team, Engineering Workflow and Leveraging Technology, Hot Topics, Integrating Care Continuum, Reforming Healthcare/Advancing Quality and Safety and Shaping the Culture. Hot Topics included Improving Patient Outcomes through Inter professional Education and Leadership. Many of the sessions dealt with teamwork, building teams, strategies and tactics to improve safety and strategy and tactical steps needed to develop a first class healthcare system

SESAM 2012’s conference program focused on safer practices in healthcare with three main themes: Patient safety – the connection between patient safety and simulation; Education – the educational aspects behind simulation; New Frontiers – simulation in healthcare in the next decade

There were three keynote speakers and each addressed one of the themes. Tanja Manser addressed Patient safety by reviewing examples of patient safety research focusing on challenges in methodological and measurement issues and the implications for simulation based research and simulation training. She compared the audience to snails (those who wanted to hold back and make sure everything was working properly before rushing headlong into development, change, etc.) and the other half- evangelist (who would rush headlong into new pursuits and be optimistic that it would all sort itself out). She said healthcare communities are using simulation to improve outcomes. However, according to her team performance research, 30 per cent of the problems /incidents are related to teamwork, coordination and communication.

Suzan Kardong-Edgren talked about New Frontiers. She highlighted many of the technological advancements that are available to us. An example she used was using an imaginary student (avatar) to teach ethics. Kardong-Edgren said avatars are becoming so advanced that one day they may replace standardized patients. She said she was definitely an evangelist and got very excited about all the apps that were available. She referenced the University of Minnesota’s Real Cause Analysis learning program for students and the University of Washington’s Team Challenge programs for students. She said that you can now play screen based games in Second life and how students today naturally work in teams. She feels future nurses, doctors and other healthcare professional s will just naturally work in teams.

Charlotte Ringstead discussed Education. She talked about the benefits of simulation based training, and effects on learning outcome, quality of practice and patient safety. She felt if you are going to discuss healthcare you have to realize that it is a huge, complex, complicated system that is unaware of its power and potential. Ringstead said one of the areas we are not sure of in simulation training is post training transfer and adaptive training transfer. The results need to be verified and validated. She also stressed that in simulations, learners should be learning from errors not practicing error avoidance.

In addition to the keynote sessions there were 200 presentations or poster sessions from 25 countries covering the broad categories above but also dealing with simulation scenario development, curriculum to return on investment in developing a simulation center. Presenters discussed curriculum development, standards, evaluation, knowledge transfer, learning objectives, decision making, team training and CRM .There were some outstanding research projects presented by young doctors. One was on patient non-compliance and how you try to change behaviors and another dealt with using simulation to train doctors in acute care.

UK Simulation Nursing Education Conference’s theme was International Simulation Standards: The Impact on Educators. The conference featured master classes, concurrent sessions, interactive workshops, and three distinguished keynote speakers. Dr. Bryn Baxendale, Director of the Trent Simulation and Clinical Skills Centre (TSCSC) and President of the Association for Simulated Practice in Healthcare (ASPiH) gave an excellent presentation talking about perceptions and attitudes and how thinking must change if we are to develop a patient centered healthcare system. Professor Judith Ellis MBE, Executive Dean for Health and Social Care at London South Bank University discussed the changes in nursing education that simulation has wrought but the need to verify and validate knowledge transfer. She discussed changes in the UK system and the impact it will have on training. Dr Jay K. Ober, National Director of Nursing Operations and Regional Dean of Nursing, Education Affiliates Inc., USA. Discussed how you motivate and train with the use of simulation and his experience in setting up networked simulation training facilities. All three conference speakers discussed safe practice in fundamental aspects of care, high fidelity simulation training for patient safety and perceptions and attitudes that have to be addressed to transform healthcare.

The master classes were round table discussions led by a nurse or simulation technician who facilitated discussion and answered questions on setting up simulation centers, key players’ roles and responsibilities and how you motivate practitioners to use.

Concurrent workshop sessions included sharing best practice and innovation through a clinical skills network to debriefing by using a toolkit of techniques. Others included standardization of training and assessment tools to a pilot study of low fidelity simulation for first year nursing students

International Association of Clinical Simulation and Learning Conference served notice that the nursing community is seeking to expand its use of simulation throughout its continuum of learning, for individual and team training skills.

A spirited and well-received conference keynote by Jennifer Arnold, M.D., provided a compelling case for the use of simulation in the healthcare community’s learning environments. Arnold parsed no words when she built a case for simulation as one tool to help increase patient safety, bolster learning efficiencies and obtain other returns on investment.

The conference schedule of events provided insights into the rapidly evolving state-of-the-art of simulation. Indeed, one of the many lessons learned from the conference, was the expanding scope of the term “simulation.” While the community uses part-task trainers and higher fidelity training devices, it is also grappling with the promise of virtual worlds and other technologies.

To the conference organizers’ credit, delegates were able to attend breakout sessions for an array of topics ranging from simulation theory to the brick-and-mortar aspects of planning and building a simulation center. Indeed, one of the more interesting sessions was a discussion on the planning and design, of medical simulation laboratories and centers to meet today’s needs and 20 years beyond. Leland Rockstraw, Ph.D., RN and Jonathan Fishman, M. Arch., noted these facilities must be built to accommodate current and planned learning technologies, and instructional requirements, in particular, accommodating after action reviews.