An Essential Guide to Hospital Simulation

For years, it’s been an open secret that a gap exists between the skills healthcare providers need to have and the academic preparation they received. While healthcare simulation is still quite young, it has evolved significantly in a short time and is an excellent tool for closing the preparation-practice gap. While it may seem insurmountable, a hospital-based simulation education will help acclimate new nurses to the skill and expectations required of them.

The Set Up

The work to set up and establish hospital-based simulation education (HBSE) will pay off with interest. Many on a hospital staff obtained their credentials when simulation was not widely used, if at all. Conversely, there are staff who were trained by well-meaning instructors who were unaware of, or disregarded best practices – the ‘simulation abused’ as some may call them. Establishing guidelines, soliciting buy in and communicating the objectives of simulation in advance will provide the most positive experience for all involved. This foundation will let you unearth inherent biases and provide the opportunity to foster buy-in. 

Buy-in

Solicit and encourage leadership buy in. Identify potential obstacles you may face in building your program, and pre-emptively address their concerns. Simulation provides a wealth of information for leaders who want to improve patient outcomes. Be sure to measure starting points and track improvements that are driven by simulation efforts. Consistent and targeted training illuminates areas for improvement and highlights current successes. Share these with leadership. 

Participants will realize better outcomes when they embrace simulation. Work on the front end to establish and communicate the goals and objectives of the HBSE programs with those who will be involved in the simulations. Solicit concerns and identify barriers prior to running the simulation. The work to provide a positive learning experience will yield word of mouth testimonials within the system, paving the way for expanding programs. 

Fidelity 

The best way to practice taking care of humans is to take care of humans. 

We don’t practice on patients. The next best thing is a human acting as the patient. Simulated Participants (SPs) also known as simulated patients, patient actors, embedded actors, and many other names, provide the ability to interact with a human while learning or improving the care of patients. Communication is a key factor in patient safety and caring for patients. Communication should be a key element of any HBSE program. Root cause analyses of most patient safety incidents involve breakdowns in communication. Human patient communication is practiced in the highest form with SPs. 

Learner Safety 

Clearly communicate fiction contracts, psychological safety, and confidentiality expectations that surround the planned events. Provide the connection for behavior expectations as they align with HR policy currently in place. 

The Simulation – Prebrief, Dry Run, Debrief

Consistency is key. Weather running an interprofessional education (IPE) scenario such as an in-situ patient deterioration simulation or providing just in time (JIT) training on urinary catheterization to decrease hospital-acquired infection (HAI) numbers, the simulation must be delivered in a consistent fashion with each group. 

When possible, safely and securely record the simulation to use for a debrief. A picture truly is worth a thousand words and an invaluable part of the debriefing process. 

Prebrief

A prebrief should be delivered prior to the start of the scenario. If running an in-situ simulation, the prebrief should be delivered prior to the unannounced event. Consider a brief online learning module, a written worksheet with acknowledgement questions, etc. 

Dry run

Make sure all necessary items are in the room. Having missing supplies does happen in the real world. However, if it’s not a planned part of the scenario, it degrades the scenario. It can also be used by a naysayer as proof simulations aren’t ideal. Dry runs provide an excellent platform for ensuring a successful scenario. Even simulation involving tasks and task training should be delivered consistently with a process developed to ensure each educator and learner have a consistent experience. 

Debrief

Bring it all home with a debrief. Find the debrief that works best for your team and apply it consistently. Develop your understanding of debrief and use it to close the loop on the simulation. This is quite possibly the most important part of the simulation. When able, use video debrief as part of your modality. 

In conclusion

Using HBSE is one of the best ways to improve processes, patient outcomes, provider confidence, and overall patient safety. Planning and consistency are key, however, once meticulous effort is applied to the set-up and development, the execution can be easily applied time and again. Fidelity will go a long way to improve outcomes and learner buy-in. Educators can also improve the overall experience by honing in on their debriefing skills. HBSE provides an improvement in team dynamics and overall communication; two areas that have a large impact on improving patient outcomes and decreasing provider burnout. 

Avkin’s SP Certificate program will take care of training SPs for you. Participants who finish the program will be trained with the best practices and be able to enhance learner outcomes. Learn more about the Avkin SP Certificate by clicking here.