Improving patient outcomes is a constant focus for U.S. healthcare providers as well as patients and government agencies. Patient safety is at the heart of current healthcare quality improvement efforts in our nation. Enhanced patient safety through a significant reduction in medical errors will save the U.S. healthcare industry millions of dollars and, more importantly, thousands of American lives.

Education is the most powerful tool in our country’s efforts to further improve patient outcomes. Today, technology-based learning is a driving force. Generation X and Generation Y healthcare providers want to learn by doing, which reinforces the cognitive knowledge they obtain during formal lectures. The need to offer this diverse programming, meet the educational needs of clinical providers in the region, maintain the workforce, and provide safe patient care are the key principles behind the creation of the WakeMed Simulation Center (SIM Center).

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Located on the WakeMed Raleigh Campus, the SIM Center is designed to facilitate realistic clinical training and education for nurses, physicians, and caregivers. In the SIM Center, healthcare providers administer treatment to human patient simulators that can bleed, cry, breathe, and die. The simulators have heart attacks, renal failure, adverse medication reactions, and other issues—just like humans. The goal is to allow clinicians to practice their skills, learn from their mistakes, and gain confidence in their abilities in a controlled, yet realistic clinical environment. They also have the opportunity to keep their skills current for those high-risk procedures in which they need to maintain proficiency but rarely have the need to perform.

The technology to operate these simulators, as well as the unique educational experience they offer, drove the design of the 3,800-square-foot SIM Center. After overcoming the greatest design challenge that most hospitals face—finding space for a new service—a team was formed to ensure the design would support the SIM Center mission. Team members included the manager of the SIM Center, a director and project manager from Facilities Design and Construction, and WakeMed’s chief learning officer.

The simulation design team examined the layout of other centers around the country, keeping in mind that the WakeMed simulation center will have a regional focus. The majority of simulation centers nationwide are specific to one organization. The WakeMed SIM Center is available to healthcare providers throughout the community and region, making the A/V and technology requirements different. But, like other simulation centers, the educational methodology is the same: SIM Centers educate providers based on the concept that hindsight is 20/20 and that ⅔ of the learning process happens after the clinical experience in the debriefing. With this in consideration, the two patient rooms are each surrounded by debriefing rooms, where students and educators go immediately after the clinical experience, to review the video of the educational experience and critique themselves.

One of the “patient care” rooms is a flex space that can accommodate medical/surgical simulated patients or labor and delivery simulated patients, depending on the educational need. The other is a critical care setting. There is also a computer room where students can test their baseline knowledge of clinical practices and educators can learn how to operate the simulation equipment. Finally, there is a replica of a hospital nurses’ station, equipped with some pharmaceutical dispensing technology, computers, and other supplies that support the patient rooms.

The setting is based on the philosophy that if the SIM Center environment is realistic, students will feel like they are in an actual clinical situation and will perform accordingly. The patient rooms are duplicates of WakeMed’s typical medical/surgical, labor and delivery, and critical care rooms. Real equipment—ventilators, heart monitors, etc.—is used in the rooms. Actual oxygen is also pumped into the rooms, which is a unique feature for simulation centers because most use simulated medical gases. The decision to use real equipment and oxygen posed a difficult challenge. If we used real oxygen, then we would also need to go to the expense of installing copper piping rather than just using rubber hoses. Because this is a business occupancy used exclusively for educational purposes and it is not under Department of Health jurisdiction, medical gases—even though they are the real thing—are clearly labeled “Simulation Gases Not for Patient Care.”

Information technology needs also created a few challenges. In all, there are 176 data drops in the 3,800-square-foot space. There are microphones and cameras suspended from the ceiling to record voices and actions during medical simulation sessions. Video is fed directly to the debriefing rooms where students can immediately view their performance after they complete the clinical scenario. Technology to support lavaliere microphones and devices for the hearing impaired are included. Instant messages can be sent from the control room to students’ cell phones, palm pilots, and computers to alert providers about simulated disasters and other events that can happen during care delivery. The rooms are equipped with incandescent and fluorescent lighting offering innumerable lighting options depending on what works best for capturing each particular scenario on camera. The SIM Center has its own servers and a dedicated data closet to house all the computer technology necessary to support the patient simulators. The technology also enables remote login, supporting distance learning.

“You can captivate learners due to the realism in a medical simulation center,” says Susan Jackson, MA, WakeMed vice-president and chief learning officer. “That’s exactly what we want: that ability to recreate team care scenarios in a true-to-life setting. Providers can work to improve communication, efficiency, and clinical skill in the simulated medical environment and learn how to avoid errors and improve patient safety.”

Building the SIM Center in our current economy was no easy task. Much of the construction was funded by a community education grant by The Duke Endowment. In addition, vendors have donated items.

This is the WakeMed Medical Simulation Center’s first construction phase. Room to grow is also available, and much of the infrastructure to accommodate the center’s future 4,700-square-foot expansion is in place. Some of the walls that are planned to be taken down for Phase 2 include simulated medical gas outlets. The audio/visual elements are also in place to accommodate the operating room, two additional patient rooms, exam room, two more classrooms, and a virtual reality room that will be added in Phase 2. An ambulance has been donated to the center so that emergency medical services providers can use the technology. A false wall will be included in the design of Phase 2 so the ambulance can be driven into the center and hooked up to the technology for a realistic mobile care educational experience. And, because WakeMed invested up front in a higher level of A/V, information technology, and vacuum pumps for the medical gases, phase 2 will be much less expensive.

With all the technology that supports the WakeMed Simulation Center, we know we will have bugs to work out along the way, but the unique educational experience it will offer caregivers throughout our region is well worth the effort.

Amar Patel is a trained firefighter and paramedic who, as manager, provides technical and operational oversight of the WakeMed Simulation Center. As an expert in designing realistic, effective healthcare scenarios for human patient simulation equipment, Patel has authored or coauthored five academic articles and abstracts on human patient simulation.

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