Weeks before the Meehan Family Pavilion at Milford Regional Medical Center opened its doors to a new Emergency Department on October 28, a few special patients had already been treated. There was a woman who went into premature labor, a child who accidentally overdosed on medication, and a man with a bacterial infection, among others.
All of these patients were in fact only actors playing their part in a SIMTest, a service provided by Boston Children’s Hospital Simulator Program (SIMPeds) that helps expose unanticipated safety issues and avoid mistakes before they arise in real-life settings. Medical simulation has grown in popularity over the past ten years, as studies show that the practice can result in “safer and more efficient care for patients, providers, and systems.”
SIMPeds conducts regional, national and international design and facility readiness tests, including tests with affiliated community hospitals such as Milford Regional. For this project, the SIMPeds team developed four simulation scenarios based on specific areas of concern, and tested them out after the $54 million expansion was complete but before the doors had opened. Mary O’Neill, MD, Medical Director at Milford Regional says, “Our much bigger space and new equipment created a lot of anxiety among the nurses, techs and physicians.”
Feedback has been very positive. “All levels of staff were really appreciative to experience the space before it opened,” says O’Neill. “Very concrete, immediate learnings came from the simulation.”
Catherine Allan, MD, clinical director of SIMPeds, is also pleased with her team’s latest simulation event and the fact that the staff at Milford Regional was able to implement changes to the facility and workflow before opening day. “Medical simulation affords a tremendous opportunity to practice before ‘game time,’” says Allan. “You’re no longer intellectualizing the operation of a new facility — you are actually doing it and ensuring the space meets your needs and is optimized for your team.”
Scroll down to see highlights from the simulation event.
“We simulated a precipitous delivery scenario where a woman delivered a baby in one of the trauma resuscitation rooms,” says O’Neill. “The takeaway here was that the rooms were noisier than our current rooms so we needed one physician to be a communicator between the delivery team and the neonatal resuscitation team. We also determined that team members outside of the Emergency Department staff should have an identifying tag.”
In attendance were all of the players that would be in the Emergency Department on a regular day: physicians, nurses, paramedics, IV therapists, respiratory therapists, secretaries and security guards. “They may not have been involved in the facility’s design,” says Allan, “and they often have very good insights.”
Because of a statewide shortage of inpatient psychiatric beds, Milford Regional’s Emergency Department was designed to board patients while they wait for placement. “Boarding patients is not new for us,” says O’Neill. “But this closed locked area specifically designed for that is new for us.” Allan and team developed a scenario where an actor playing a psychiatric patient tried to escape. “We often use actors to enhance the emotional realism and allow the staff to engage more fully,” says Allan. The simulation allowed O’Neill to see that the hospital’s patient safety assistants and security guards were able to successfully deescalate the patient, while the doctor on call was busy with a critically ill patient.
A live stream of the SIMTest was set up for hospital leadership, members of the board of trustees, and any clinicians not involved in the simulations. O’Neill, who was observing, says, “We noticed that one of the doors to the charting area swung out,” she says, “which was potentially dangerous if patients used it as a weapon or blockade, or if someone accidentally slammed a finger in it.” The door has since been removed.
Learn more about SIMPeds at Boston Children’s Hospital.