The mannequin, representing an 89-year-old woman, is lying on a stretcher in the preoperative area prior to surgical repair of a hip fracture. The anesthesia resident and preoperative nurse are conducting their final checks when the mannequin states, “I can’t breathe.” The nurse had started the patient’s Kefzol 1 gram prior to entering the operating room. The patient’s heart rate increases from 60 to 150 and her blood pressure drops to 50. When the resident listens to her breath, he hears wheezing in her chest. The resident and nurse must now determine what has happened and the appropriate course of treatment.
Over the next 10 minutes, a simulation trainer will watch through a one-way window as the nurse and resident respond to the patient’s anaphylactic drug reaction, which will include the administration of medications and intubation of the mannequin followed by cardiac arrest. For the participants, the scenario feels like a real emergency as they go through all the necessary resuscitation maneuvers.
Welcome to the world of medical simulation, where caregivers use computer-controlled equipment to develop and refine skills, and learn new procedures and treatment protocols before using them on actual patients. Soon Boston Medical Center staff will be performing simulation exercises in a state-of-the-art facility.
This month BMC will complete construction on a 5,000 square foot simulation center in the home of the former Newton Pavilion Emergency Department. The new center will consolidate the various simulation areas around the hospital, including those located in Anesthesia, Nursing, Pediatrics and the Menino Pavilion Emergency Department.
BMC’s high-fidelity simulation center, to be called the Solomont Clinical Simulation and Nursing Education Center, will give staff the most realistic simulation experience possible using mannequins programmed with pre-defined scenarios. Entire teams will train while video cameras capture their actions for review in debriefing sessions following the simulations. The experience is as real as it gets, says Keith Lewis, RPh, MD, Chair, Anesthesiology.
“Simulation brings cases to life,” says Lewis, who has overseen the development of the center along with Lisa O’Connor, RN, BSN, MS, NEAA-BC, Senior Vice President for Clinical Operations and Chief Nursing Officer. “It’s not a technology, but a technique. It allows you to see the roles of various people, prevent errors and problems before they occur, and define how to get to a better outcome.”
The interdisciplinary Center will allow BMC/BUSM staff, faculty and residents to perform all simulation on site, which sets BMC apart in the Boston academic medical center community.
“Nursing, physicians and allied health professionals will routinely train as teams for high-risk scenarios as opposed to doctors and nurses training independently,” says Lewis. “We will be the only center in Boston to perform simulation this way.”
The Center’s vision was developed by BMC/BUSM leaders with the common goal to create a simulation area that trains the caregivers of today and tomorrow to provide the safest care to BMC patients. That focus, of putting the patient first, is what the simulation center is all about, says O’Connor.
O’Connor and Lewis in the new Solomont Simulation Center
“The Center is symbolic for changing the way we train and learn together,” she says. “We are working as a team focused on the patient, which is the crux of the patient safety culture. Through this continuous learning, we will continue to capitalize on BMC’s performance in quality and safety and our quest to Be Exceptional.”
“The goal is for simulation to become embedded in our system and part of our everyday culture,” adds Lewis.
The Center, which can accommodate up to 150 people, will feature three high-fidelity simulation rooms, two task training rooms, two control centers, a classroom and conference room, and office and storage space. The Center will be outfitted with a mix of current and new equipment, all of which will be on wheels to allow for flexibility within the space. It will be overseen by four departments: Anesthesia, Emergency Medicine, Nursing and Pediatrics, and staffed by a simulation coordinator. The Center’s construction began last October and will be completed this month. The Center will open for use in March.
Substantial funding for the Center was raised at the 2011 BMC Gala, where donors gave $1.7 million for its construction. Other donors include longtime BMC partners Anaesthesia Associates and the Massachusetts Memorial Hospitals Nursing Alumnae Association (MMHNAA). In addition, the BMC Medical and Dental Staff have given $400,000 toward this effort over the past four years. The Solomont Clinical Simulation and Nursing Education Center is named in honor of former vice chair of the BMC Board of Trustees Alan Solomont and his wife Susan Solomont, who were honored at the 2011 Gala. Space within the Center will named for Erwin Hirsch, MD, BMC’s long-time Chief of Trauma Surgery, and in recognition of major support from the Ross Fund of the MMHNAA, and for Dr. Ellison Pierce, a colleague of the Anaesthesia Associates.
O’Connor notes that non-clinical teams will be able to use the Center to train for emergency preparedness scenarios, communication and de-escalation situations.
“It will give us a method to assess the preparedness of our institution,” she says.
O’Connor and Lewis believe that as team training and simulation grow, BMC will become a more fully integrated health care team.
“It’s what our patients deserve,” says Lewis.
The Solomont Clinical Simulation and Nursing Education Center will be open five days a week beginning in March.