Simulated Scenarios, Real Benefits
Jul 26, 2017 Cedars-Sinai Staff
The patients Russell Metcalfe-Smith assists resemble human beings.
They talk and bleed. Some even appear to give birth. But they aren't your average Angelenos.
They're human patient simulators: lifelike mannequins that help healthcare professionals at Cedars-Sinai practice real-life scenarios.
"You program them to say anything or respond in any way you want," says Metcalfe-Smith, manager of the Women's Guild Simulation Center for Advanced Clinical Skills at Cedars-Sinai. "They very much reflect the physiology of a real human being."
Simulating the real thing
Metcalfe-Smith joined Cedars-Sinai to help create the simulation center. A registered paramedic, he spent more than a decade leading resuscitation services and simulation centers for major hospitals in the United Kingdom’s National Health Service.
The human simulators at Cedars-Sinai are part of a 10,000-square-foot facility that includes two fully-equipped and functioning operating rooms, an obstetrics and gynecology room, adult and prenatal intensive care units, and a trauma bay, along with classrooms and areas for education and skills training.
The simulation center provides hands-on training for more than 20,000 users each year. That training includes educational collaborations with Los Angeles schools, fire, and police services. Most of the simulation center's users are the doctors and nurses of Cedars-Sinai.
"Other hospitals do have these types of learning facilities," Metcalfe-Smith says. "The difference at our simulation center is the level of fidelity and realism. There are not many hospitals that have built actual operating rooms with real equipment. There are not many centers with true ICUs. It's a much more realistic environment here."
"That's a key thing, living it before you physically have to do it."
The scenarios that play out in the center can be complex and dramatic. They've included heart surgeries for babies still in the womb, emergency intubations with complications, chest surgeries for pediatric patients—even operating room fires or simulated earthquakes complete with moving floors.
If the mannequins aren't "real" enough, Metcalfe-Smith's team can use 3-D printers to design and manufacture custom parts to make more realistic scenarios possible by precisely re-creating specific anomalies that can occur in real world patients.
Training as a team
The behind-the-scenes efforts to achieve accuracy serve a vital goal.
"The simulation center trains people together as teams and not as individual professions," Metcalfe-Smith says. "Traditionally, physicians and nurses are taught on their own. Then you suddenly expect people to function well together in a hospital system that's all very complicated."
"But if you can bring them together first in a simulated environment, you are developing teams and cohesiveness that ultimately improve patient care and patient outcomes."
Cedars-Sinai has the ability to quickly deliver a range of simulations based on the hospital's needs. If there is a complex surgery scheduled or new technique to master, the simulation center can be used in the planning.
"You are developing teams and cohesiveness that ultimately improve patient care and patient outcomes."
"We've had physicians who have undertaken a simulation experience and then verbally thanked us for—from their perspective—helping to save a patient's life," Metcalfe-Smith says. "What we were able to mimic in the simulation center is what happened in reality. Therefore, they were able to perform at a much higher level and manage a patient in a life-and-death situation."
Because of simulation training, nurses have gained greater awareness in recognizing patient medical issues at bedside and gained more confidence in notifying attending physicians.
More research programs that explore unique human variables and unexpected challenges are on the horizon in future simulation planning. There will also be cooperation with the healthcare industry to help improve its products.
"Simulation in healthcare is still in its infancy," Metcalfe-Smith says. "As technology becomes more realistic, there is very little excuse why a real patient should be the first experience any clinician has performing a skill or technique."
"As technology becomes more realistic, there is very little excuse why a real patient should be the first experience any clinician has performing a skill or technique."
"That's a key thing, living it before you physically have to do it. If you're exposed to something—even if it's not a real person but realistic as you can make it—it's going to give you far more confidence to deal with that situation in real life. And consequently, that can be lifesaving."