Taking In Situ Simulation On The Road

July 30, 2015 

It's my hope I won't ever have to deal with any emergencies concerning my two-year-old boy. However, I feel a certain level of comfort knowing he'd be taken care of at Children's Hospital of Illinois. It's equipped to deal with the direst of needs, has pediatric in-patient units, and cares for more than 18,000 babies and children annually in the emergency department alone.

It's easy to take this care for granted as it's in my own backyard. But consider hospitals with emergency departments in rural areas. It's likely they don't have pediatric in-patient units, and maybe see up to two babies or children a week. Regardless, they have to make sure they have the education, tools, and resources to accept these patients in an emergency.

Jump is working to ensure our regional hospitals within OSF HealthCare have what they need to take the best care of our small patients. And we're doing that by bringing simulation into their hospitals.

Introducing In Situs In Regional Hospitals

About 9400 learners have participated in various simulations in the last two years at Jump, but many of them are from the immediate Peoria area. OSF, Jump leadership and faculty made up of Drs. Trina Croland, Lisa Barker, Ann Willemsen-Dunlap, and Rose Haisler are reaching out to our regional hospitals to conduct what are called in situ simulations-meaning health care professionals get to practice life-like medical scenarios in their own clinical environments.

Michelle Sheppard is the Clinical Coordinator for the Children's Service Line at Children's Hospital of Illinois. Her role is to find out what resources regional hospitals need to deliver the best care to pediatric patients.

"Most of the time it's not a question of skills, even though the staff feels that their skills are not up to par-they really are. It's more of a confidence issue," said Sheppard. "They don't see the number of pediatric patients that we do. So having them do simulation in their environment with their own equipment and own ancillary department staff is so important."

Performing in situs in regional hospitals can provide insight into how medical employees are working and communicating as a team to solve problems. They also help clinicians determine if they have all the equipment they need in an emergency and if those supplies are in an easily accessible place. Jump is helping hospitals close any gaps in care.

Jump Chief Medical Officer, Dr. John Vozenilek, says there's a third takeaway for those participating in in situs as well.

"It has to do with just inspiring people to think about how their role has an impact on patient care. So setting the stage for what it means to be part of OSF and to display a compassionate competence. Being present and in the moment on such a high-stakes learning environment such as an in situ seems to be inspirational for people."

Running An In Situ (Putting Learners At Ease)

The teams of learners are typically made up of nurses, a patient care or emergency department technician, respiratory therapist, and physician. Participants are briefed on the scenario they will encounter, their surroundings, and the manikin they will work on. The simulation runs about 20 minutes.

Dustin Holzwarth is a simulation specialist who helps run the in situs.

"Typically, the scenarios we've done with our in situs involves a patient that is decompensating pretty rapidly," said Holzwarth. "Interventions need to be done in an organized and effective way to turn the case around. I think with any simulation, you need to have that sense of urgency for the learners."

The in situ doesn't end after participants are finished with the simulation. The learners then go through a debriefing session.

"The debriefing is by far the most important time and that's where everyone comes together and talks about what happened in those 20 minutes," said Sheppard. "What did we do well, what can we do better, how did everyone feel about it? We get a lot of valuable information from that."

Making Changes to Improve Care

This particular simulation pointed out some areas for organizational improvement in the emergency department. Fleming says the in situ led to OSF St. Mary redesigning a trauma room specifically for young patients.

"It really brought awareness to where we were weak. A lot of times in kids-time is life. If you're running around and you don't know where things are, that child is waiting for treatment and that's not good. So it's brought a lot of awareness to our ER. We've also redesigned our pediatric crash carts to make them more organized and user-friendly and that's helped the entire hospital."

The training came just in time. Two days later the emergency room team received a pediatric code-a rare occurrence for the small hospital.

"We got a lot of positive feedback from the staff working that day--how things went smoothly, everyone knew where things were," said Fleming. "Staff had the confidence to know that room had the equipment that they would need to resuscitate a child."

Monica Sharick is also a simulation specialist who's part of the Jump in situ team. She's joined by Holzwarth in discussing what it's like to implement simulations in regional hospitals.

"It's just amazing to see and hear the stories of how we've helped not even patients but the staff at these outlying hospitals. It's neat because we're making a difference," said Sharick.

"Yeah, ultimately we're finding we can go in and alter the culture inside of that department and that's what drives me," said Holzwarth.

The Future of the In Situ Program

Dr. Vozenilek says the larger goal is to eventually turn in situ duties over to who he dubs the "local champions" of each hospital.

"What we envision in the future is, instead of us coming with all of our kit, instructors, and the whole to-do, they would simply call us up and say they would like to schedule such and such for this day. And then we're just sending perhaps, device or technical expertise. But the local champions actually own the process. In this way, we're really planting the seeds for little Jump simulation programs to be launched across the Ministry."

Jump staff has mostly been focused on carrying out pediatric in situs. But it's expanding to include operating room emergency simulations as well as other in-patient and out-patient settings. The long-term vision is to bring in situs to every hospital within the Ministry as well as other partners that feed into the OSF Healthcare System.

The work that Jump and OSF are doing significantly impacts the way interprofessional teams work together in fulfilling our mission of serving patients with the greatest care and love.

Denise Molina-Weiger is a Creative and Digital Writer for OSF HealthCare, where she has worked since March 2015. She initially came to OSF to write about the work taking place at the Jump Trading Simulation & Education Center, one of the largest simulation and innovation centers in the world, and went on to become the Media Relations Coordinator for OSF Innovation which was developed to help the hospital system lead the way in transforming care.  Before joining the OSF HealthCare team, Denise was a reporter for Peoria Public Radio for ten years, writing on everything from politics, housing and transportation issues to hospital care in the region.