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Embracing Medical Simulation

 

 

“SimLEARN is already the VHA’s national simulation center and will be even more so once we get into the building,” Robinson continued. “But right now we’re essentially a hub with 150 spokes – all the VA Medical Centers that have facility simulation training centers.”

As a representative example of recent results from the hub-and-spoke concept, he pointed to the 2015 creation of a Facility Simulation Training Center Certification Program. The three-tiered process identifies criteria for basic, intermediate, or advanced certification, with VA Centers solicited to apply for certification on a bi-annual basis. The initial rollout occurred in February 2015 and resulted in certification for 20 of the centers.

“I see the use of medical simulation continuing to grow across the Department of Veterans Affairs. We have great leaders in VA who see its utility and strongly support it. They ‘get’ what we do and see further applications in the future.”

Another significant activity example identified by Robinson is SimLEARN’s “Hospital Activations” program.

“VA is opening a number of new hospitals,” he explained. “They did one in Las Vegas about 12-18 months ago. They are opening the Orlando VA Medical Center this year. Next on the schedule is New Orleans and then Denver. These are major facilities being built. If you look at the one in Orlando, for instance, you’re talking about a 1.2-million-square-foot facility. And one of the services we’re providing for hospital activations is to go in before they open and help them by running them through various processes and patient flows and to see how they will handle various emergencies. For example, what if somebody ‘codes’ in the cafeteria? What if a patient becomes belligerent in a dental chair? We use confederates [role players] or manikins and we will run them through all their procedures. We’ll document how they did and give them feedback. Then at the end, for each subsection that participated, we will identify the latest safety hazards, classify them for probability and severity, and then give the report to their leadership so that they can address these scenarios even before they open the doors.”

The SimLEARN simulation activities take place prior to new hospital accreditation by the Joint Commission of Accreditation of Healthcare Organizations (JCAHO).

“Even before JCAHO and ribbon cutting they’ve already seen a number of adverse scenarios and are well versed on how to handle the situations,” he said. “It’s a little different than simulation-based clinical training. Instead, it’s simulation-based process evaluation.”

“We’ve done it on a smaller scope for some of the clinics or wings that have opened at existing hospitals,” he added. “And we’re in the process of developing a course here so that we can teach facilities how to do this on their own.”

“Applying simulation-based training in the medical field clearly provides numerous benefits,” Robinson summarized. “It provides a safe training environment where no harm can ever come to a patient. You can also target exactly what you want to train on a given day. And we get to teach to a mastery level, where the students can perform a procedure numerous times, just like a military pilot can practice in a simulator for landing on the ship at night. They can learn the muscle memory and all the cognitive skills. They can do it so many times in the simulator that they become proficient at the task. And this is key in health care, where there are numerous procedures that providers might not get to see without the opportunity of simulation.”

“I see the use of medical simulation continuing to grow across the Department of Veterans Affairs,” he concluded. “We have great leaders in VA who see its utility and strongly support it. They ‘get’ what we do and see further applications in the future.”

This article first appeared in The Year in Veterans Affairs & Military Medicine 2015-2016 Edition.

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Scott Gourley is a former U.S. Army officer and the author of more than 1,500...