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Taking Education to the Healthcare Team

In-situ Simulation in Acute MI Care as a Model for Team-focused CME

Tuesday, June 15, 20102:00-3:00 PM ETAlliance for CME

Presenters

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Laura Lee Hall, PhDAssociate Director, Strategic Educational Initiatives

American College of Cardiology

Elizabeth YarboroAssociate Vice President

American College of Cardiology

Let’s Get On the Same Page

Introduction and Disclosures

Laura Lee Hall, Ph.D.� Associate Director, Strategic Educational Initiatives, American

College of Cardiology� Does not have an interest in selling a service to CME professionals

Elizabeth Yarboro� Associate Vice President, Professional Development & Education

Division� Does not have an interest in selling a service to CME professionals

Objectives

To answer the following questions:�What is in-situ simulation?�What is its educational significance?�When and how can you apply

simulation?

First, some acknowledgments…

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Simulation TeamACC Team

Laura Lee Hall, PhDProject DirectorAssociate Director of Strategic Educational Initiatives

Obsie DebelaSpecialist

Melissa KetchumSenior Specialist

Amanda PauleyAssociate Director, Educational Grants

Elizabeth YarboroAssociate Vice-PresidentProfessional Development & Education

Western Michigan University – Center for Simulation Research Team

William R. Hamman, MD, PhD Principal Investigator

Graham Bostrom, BSTechnician

Chester Dalski, AAS, BS, RN-P, EMS I/C, MATechnical Director

John Niehaus, BSTechnician

Beth Seiler, MSResearch AssociateVice-President PSOne, Inc.,

Jennifer SmithAssistant

Mentice Inc. Team

Cynthia DeMeyer RNClinical Application Specialist

Ben Speich, BSCustomer Service Engineer

This project is supported by an educational grant from Pfizer and St. Jude Medical, general educational support for ACCF’seducational programs from Medtronic Foundation, and by the ACC

Commercial Support

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Single Most Challenging Problem Reported by Responding Hospitals (n-522)

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

ED physicianactivationof cath lab

Single callactivationof cath lab

Cath lab teamavailable 20-

30minutes after

page

Prompt datafeedback

Seniormanagementcommitment

Team-basedapproach

Otherchallenging

problem

Per

cent

age

of h

ospi

tals

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What is In-situSimulation ?

• Simulation exercises conducted on actual patient care units involving actual healthcare team members employing actual organizational processes– psychologically engaging learning experience– more than training and performance

assessment methodology: part of larger organizational culture change initiative

DOOR TO BALLOON IN SIMULATION

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Control group I (n=15)- Matched controls; no

interventionControl group II (n = 5)

- Informed consent/pre-simassessment

- One simulation - EMS- Brief, general debrief- Post-assessment- Receipt of post-simulation

report

Experiment group (n=10)- Informed consent/pre-sim

assessment- EMS – simulation- Deep debrief- First post-assessment- Walk-in simulation- Post-assessment- Receipt of comprehensive

post-simulation report

-30 of 81 volunteers selected from CathPCI Registry® a nd ACTION Registry®–GWTG™-Participants selected and matched based on D2B time , caseload, +surgical back-up, geographical diversity, and comm itment of hospital leadership

In-situ Simulation:Project Design

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Project Milestones

Beta-test

1st advisory Group meeting

Second beta-test

15-hospitalimplementation

Data analysis

Conducted 10/7 – Henry Ford Hospital

November 12 th – New Orleans

Conducted 2/21 – Mercy Hospital

May-October 2009

End of 2009/Mid-2010

Dissemination of results

June-December 2010

Information Sources on STEMI System

• Pre-selection survey• STEMI treatment algorithm from

EMS/ED/Cath lab• Lab orders

• Pre-simulation survey

Pre-selection Survey

• Contact information for leadership in EMS/ED/Cath lab

• Questions concerning: EMS-ECG capabilities and use; cath lab activation methods (who activates the lab, pre-activation diagnostic tests); time for cathlab readiness; transport from ED (or EMS) to cath lab; walk-in registration approach

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Sample Rating Form

Effective transfer of information during transition and careComplete clear communication (closed loop) 1 2 3 4 5 NAAnnounces changes in patient condition 1 2 3 4 5 NAAssign and reassign tasks 1 2 3 4 5 NA

Defining RolesCare Leader clearly defined 1 2 3 4 5 NACare Coordinator clearly defined 1 2 3 4 5 NACare Givers clearly defined 1 2 3 4 5 NA

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Teamwork Skills Correlating with Outcomes

Announce plans, seek confirmation/consultation

Verbalize potential threats and risks

Communicate clearly what is needed from outside depts.

Brief team on situation and goals

Follow-up until need has been met

State directions clearly, in commonly understood

language

Assign and re-assign tasks to personnel

Ask for patient and family information/input

Update patient on changing conditions

Request clarification of ambiguous answers

Announce significant changes in patient status

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Common System Barriers

• Transporting the patient in healthcare system

• Difficult interdepartmental communication• Undefined team member roles as the

catheterization team came together in the room

�Transfer of clinical information between departments�Communication with patient

Common System Barriers!

At Last!

Where Do You Keep Your Notes?

CME/CE Evaluation Data

Hospital Post-simulation Interview Results Concerning Action Taken to Improve Acute STEMI

CareNumber of Hospitals

Action Taken

4 Reconvened participants to review simulation videotape and discuss implications for care processes

2 Planning to use video-recording for future education

3 Developed patient information forms to assure transfer of vital patient information in real time between departments

4 Working to better specify health care staff functional roles in ED and/or catheterization laboratory

3 Developed methods for better communicating care plan to all staff in the catheterization laboratory

1 Used in Chest Pain Center certification process

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Relevant Lessons Learned

• Can implement in situ simulation in complex healthcare environment – BUT requires lots of teamwork!

• Educational model appears to improve teamwork, communication, and systems

• Model of combining education and research

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For the CME Professional

• Work in collaboration with clinical content experts and core competencies

• Partner with experts in simulation/technology

• Bring QI into the mix

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FOR MORE INFORMATION CONTACT: LHALL@ACC.ORG

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