Since starting my career in medical simulation in 2008 I have had the pleasure of touring hundreds of healthcare simulation centers around the world. As a simulation enthusiast I am always excited to tour these learning healthcare education technology spaces to capture the unique aspects that come together from different teams, cultures, needs assessments, budgets and styles. Very rarely, however, do I come across such magnificent healthcare simulation design innovations that my jaw drops while goosebumps crawl up my arms. The Women’s Guild Simulation Center For Advanced Clinical Skills at Cedars-Sinai of Los Angeles provided several of such spine-tingling moments.
Does this look like a Healthcare Simulation Lab?
When Russell D. Metcalfe-Smith, Manager of the Women’s Guild Simulation Center For Advanced Clinical Skills, rounded the corner with me into their high-fidelity simulation hall I could barely believe my eyes. Entering the first room I didn’t feel like I was walking into a sim lab but rather a fully-functional ICU. Every detail was identical to the ICU room across the bridge; from the walls, floors, ceilings, and lights to the equipment, furniture, dressings and supplies — in fact the only item that was simulated was the patient, a Gaumard HAL 3201 wireless manikin. “Russell”, I said staring at the future of healthcare education, “this… this is how simulation is supposed to be look!”. Room after room brought the same quality of detail as we toured through the OB/GYN, ED Trauma, NICU/PICU, Stortz OR and Olympus OR sim lab rooms. The center also includes a fully equipped computerized simulation room with simulators for practice in GI/ bronchoscopy procedures; laparoscopic, hysterscopic, urologic, neurologic and cardiovascular procedures; and ultrasound procedures and robotic surgery.
My tour made it abundantly clear that top leadership of Cedars-Sinai that included Dr. Bruce Gewertz, MD Surgeon-in-Chief, Chair of the Department of Surgery, VP for Interventional Servicess & Vice Dean of Academic Affairs; Dr. Shlomo Melmed, MD, MACP, FRCP Senior Vice President of Academic Affairs & Dean of the Medical Faculty; and Dr. Linda Burnes Bolton, DrPH, RN, FAAN, Vice President of Nursing & Chief Nursing Officer took the investment into a state-of-the-art medical simulation program very seriously. Such vision took an incredible partnership with the Women’s Guild of Cedars-Sinai, a group dedicated to supporting patient care, vital medical programs and equipment, biomedical research, and education at the hospital. The Women’s Guild “provides resources for a wide range of programs, supporting the pursuit of knowledge and the development of diagnosis and treatment methods that will make a difference in the lives of countless patients for generations to come”. By constantly improving the skills of clinical staff, Women’s Guild is providing a resource that benefits every department at Cedars-Sinai and the patients they serve. The Guild plans to fulfill a pledge of $10 million to the Simulation Center within five years providing for the ongoing acquisition and maintenance of vital equipment, robotics, and new technology — ensuring the Simulation Center will remain state of the art for generations to come.
While such financial investments can go a long way to ensure that healthcare professionals are utilizing the latest training technology in the most realistic settings, Russell and I both agreed over lunch that the team behind the simulation program is where all the “magic of Hollywood” really happens.
HealthySimulation.com’s Lance Baily (HS): In this managerial role tell us how you utilize your background as an Executive Healthcare Simulation Consultant and the Operational Manager of NHS London’s Resuscitation, Simulation and Clinical Skills Centre as well as extensive experience in resuscitation and paramedic training program development?
Cedars-Sinai’s Russell Metcalfe-Smith (RMS): Expanding upon the knowledge and skills that were already here I was able to see where Cedars-Sinai was and add my experienced perspective to improve upon the design and development plans. Initial misidentifications which occurred before I was hired were corrected by having the team re-examine the end user requirements and then going back to them, again and again. We found we needed a way of translating the leadership’s “plain English” vision of the space to high-level technical jargon. In-house specialist and Media Systems Engineer Thavaro Soeur was instrumental in providing this translation by utilizing his extensive background in a/v production and electronic engineering to convey the leadership’s needs to external hardware installer/integrator Level 3 Healthcare.
HS: I have seen the execution of some incredible visions today, to make simulation as real as possible. Tell me about the simulation program that’s been built here?
RMS: Cedars-Sinai is a 896 bed hospital with approximately 11,000 employees which also focuses on academic research, education, student nurses and residency programs. The simulation program here mostly focuses on residency and post graduate training with a strong focus on team management and communication practices through proven systems like TEAMSTEPPS, SBAR, SCORE, and CUS.
Cedars-Sinai has been one of the most positive experiences of my career, it’s an exceptional organization to work for as they do want to make a difference for patient safety. Invested leadership is so important to developing a simulation program, as its a two way street where staff and administration must work hand and hand. The goal of the simulation program is to improve patient safety initiatives by bringing teams together from nursing, RT, medicine, residency programs and other allied health staff. While new healthcare learners do utilize the simulation center, the majority of our 1500 people attending training events a month are focused on ongoing training for our qualified healthcare professionals.
Beyond orientations and general ongoing education, we’re doing some very highly complex simulation training scenarios here including congenital heart surgery, hysterectomy, open laparotomy, pediatric thoracotomy, and OR fires / earthquakes with moving floors. To train for these high acuity cases the actual surgical teams will come down to the simulation center and utilize rooms that are carbon copies of their clinical environments to experience the procedure in its entirety, going as far as to utilize our 3d printer technology to build the patient’s unique anatomy. Simulation at The Women’s Guild Simulation Center for Advanced Clinical Skills is special because it is completely real, an exact replica of what our healthcare professionals will be working with. By visualizing reality, talking through the case and then running a nine hour long simulation our surgeons and healthcare teams are better prepared.
HS: So our audience of healthcare simulation champions is aware, give us the key statistics about the simulation space.
RMS: Of course, the Women’s Guild Simulation Center for Advanced Clinical Skills….
- Opened October 1st 2013 after 18 months of planning & development by nursing, allied health, medical and administrative stakeholders
- 10,000 square feet
- 2 fully equipped and functioning operating rooms
- 1 intensive care unit
- 1 obstetrics/genecology room
- 1 trauma bay
- 1 prenatal intensive care unit/neonatal intensive care unit
- Multiple rooms for skills training and development with computerized simulators for practice in gastrointestinal/bronchoscopy procedures; laparoscopic, hyterscopic, urologic, neurologic and cardiovascular procedures; and ultrasound procedures and robotic surgery
- 3 debriefing rooms equipped to receive and project live video feed from the simulation rooms
- Approximately 1,500 users per month
- Operating 6 days per week
- A/V Installation by Level 3 Healthcare
- Utilizing B-Line Medical for A/V Recording & Debriefing
- Holds 13 Gaumard manikins that can blink, bleed, talk, hyperventilate and give birth
- 1 Syndaver anatomical simulator that looks and feels completely real and allows for the practice of surgical techniques
HS: Seems like the Women’s Guild Simulation Center is already doing so much — where is the program going next?
RMS: There’s two exciting arenas we will be focusing on in the future: Building more research programs specifically examining human-factors using simulation to reduce adverse events and working with healthcare industry to help improve their products with increased reliability.
HS: What advice do you have for others building a healthcare simulation program?
RMS: Every organization needs to look at what their training needs are and hire staff from there. For example, at Cedars-Sinai we have dedicated IT support staff so we hired healthcare simulation technology specialists with stronger backgrounds in areas we were lacking including moulage, A/V, and manikin operation.
HS: An ounce of prevention is worth a pound of cure.
RMS: Exactly. It’s the behind the scenes staff that makes simulation work. Only 10% of simulation is the clinical component, the 90% of simulation work is done by staff “behind-the-scenes”. It’s also crucial to work with an A/V integrator like Level 3 Healthcare where you can make a direct phone call to CEO Brad Peterson and know that even though his team is in another state, they will fly out next day if there is an issue that needs immediate correcting. Because of their assistance, our audio capture is in a premium class — people forget that “audio” is half of “audiovisual”. You need a team of professionals to make simulation work. Fuse the IT, A/V, Medical, Nursing, Allied Health, Administration, Facilities, and simulation staff together and marry their work to the vision.
HS: Steven Spielberg, a major contributor to Cedars-Sinai, once attributed his success to hiring the right people and getting out of their way.
RMS: And not only has Cedars-Sinai leadership hired the best, but they have also endorsed the best with unparalleled support.
Learn more about the Cedars-Sinai Women’s Guild Simulation Center For Advanced Clinical Skills through the following links: