Board 271 - Program Innovations Abstract Using Standardized Patients to Train Employees in High-Fidelity Simulations Prior to Opening a New Unit (Submission #447)

Abstract

Introduction/Background After being closed for 18 months and undergoing a $9 million renovation, the Western Pennsylvania Hospital (WPH) reopened the Cardiovascular (CV) Institute in May, 2013. Although some of the staff members of the WPH unit may have had previous experience in caring for patients pre, peri and post invasive cardiac procedures, some staff members were novices, not accustomed to having a CV Unit onsite. So prior to reopening the unit, staff members from various departments participated in high-fidelity patient transfer simulations, preparing intraprofessional team members to provide safe, standardized, efficient, patient-centered quality care to Cath Lab patients. Staff members from the Cardiovascular Unit along with physicians, nurses, respiratory therapists and monitor technicians from other departments participated in three patient transfer simulations: an Emergency Department (ED) transfer, a T9 unit transfer, which is a medical step-down unit and a LifeFlight transfer. The former two simulations incorporated standardized patients (SPs) and hybrid simulation, adding realism and allowing participants to practice communicating with SPs as live patients. These former simulations are the focus of this abstract. Methods The goal of these simulations was to provide team members with the experience needed to safely transport and handoff patients. These simulations were repeated until the participants’ performance reached satisfactory levels using standardized checklists. Prebriefing sessions were held to explain the purpose of the simulations and to answer any questions. During each simulation, leaders from the departments involved and staff members from the simulation center observed the performance to monitor whether or not certain technical tasks were completed and to evaluate the team’s non-technical skills. After the simulations, the SPs, course facilitators and simulation observers participated in debriefing sessions. Intraprofessional team members reflected on their communication skills and on how they made the SP feel during the transfer, specifically in regards to the SPs comfort and anxiety levels. In general, both the ED and T9 teams performances improved from the first simulation to the final simulation. In the ED "private car" scenario, the mean door-to-ECG time decreased from 5 minutes to 3.33 minutes and the mean door-to-first-contact-with-the-Cardiovascular-Unit time decreased from 10.75 minutes to 7 minutes. During the first T9 replication, some observers rated the team’s communication skills as "poor" or even "fair." However, during the second and third replications of this scenario, all of the observers (100%) categorized all of the team’s non-technical skills (task management, communication, leadership and situation awareness) as "good" or "very good." After the simulations were complete, the ED and T9 participants were asked to complete course evaluations. All of the ED survey respondents reported that they were "Extremely Comfortable" in transferring patients arriving by car or ambulance to the Cardiovascular Unit and most of the respondents (80%) also felt this way in regards to handing-off a patient to the Cardiovascular Unit staff. When the T9 team members were asked how comfortable/uncomfortable they were in transporting and handing-off patients to the Cardiovascular Unit, the average responses were both approximately sixes on 7-point scales, (M = 5.60 and M = 6.20, respectively) indicating high levels of comfort. Results: Conclusion Through these simulations, departments were not only able to get acquainted with each other but were also given the opportunity to practice working together in a risk-free environment. Participants communication skills in the realm of transferring and handing-off patients were refined to ensure that the exchange of information between departments is thorough and accurate. By participating in high-fidelity patient transfer simulations, the teams also became more cognizant of proper hand-off policies and standardization of care. Disclosures None.