Fact Sheet Simulation Center at VA Palo Alto Health by kbrillhart


									                                             Fact Sheet

                                Simulation Center at
                           VA Palo Alto Health Care System

    The Simulation Center at VA Palo Alto Health Care System is key facility for patient safety
education, training, and research. It is part of the Patient Simulation Center or Innovation (PSCI). The
investigators of the Simulation Center invented the modern hands-on patient simulator in 1986-1987.
They built two generations of patient simulators themselves after which private industry began to make
simulators available commercially. The Simulation Center now has five patient simulators – two are fully
model-driven systems (MedSim Eagle Simulator and the METI Human Patient Simulation Version 6),
and three are medium-fidelity script-driven – 2 Laerdal SimMan devices and 1 Laerdal SimBaby).
    Each patient simulator consists of a computerized mannequin controlled by complex mathematical
models of the human body’s behavior or by scripts. Mannequins have clinical features such as breath
sounds and heart sounds audible with a stethoscope, pulses that can be felt, moving eyelids, pupils that
dilate and constrict, moving limbs, and spontaneous breathing. Clinicians can perform many procedures
on the mannequin including insertion of a breathing tube into the windpipe. The simulator provides many
signals to real patient monitoring equipment including electrocardiogram, blood pressure, oxygen levels
(pulse oximetry), exhaled carbon dioxide, and temperature. The model-driven simulators recognize over
70 drugs and the patient responds appropriately based on mathematical calculation of drug effects. A
large variety of abnormal events can be triggered, including such things as a heart attack, cardiac arrest,
severe bleeding, and severe allergic reactions.
                                                                   Simulation Room 1 at VA Palo Alto
                                                                   HCS configured as an operating room.
                                                                   The patient mannequin is on the
                                                                   operating table, with its head just
                                                                   visible below the drapes. Arthroscopic
                                                                   knee surgery is about to begin. All
                                                                   patient monitoring and life-support
                                                                   equipment is real.

                                                                     The Simulation Center is a 2200
                                                                 square foot facility dedicated to patient
                                                                 simulation for training and research in
                                                                 health care. The facility contains a
                                                                 fully-equipped replica of an operating
                                                                 room which can also be configured as
a delivery room) while a second simulation room is configured as a bay for an intensive care unit,
emergency department, or ward room. Each site can accommodate two patient simulators. In all parts of
the facility real clinical equipment is used. A sophisticated computerized audio-visual system in each
room provides multiple views of the action in the simulation room for use in debriefing simulation
participants, or for research.

                                              Fact Sheet

                                 Simulation Center at
                            VA Palo Alto Health Care System
    Simulation Center investigators have pioneered advanced clinical training using the simulator. In
1989-90 they developed a curriculum in Anesthesia Crisis Resource Management (ACRM), modeled after
Crew Resource Management (CRM) training in commercial aviation. ACRM stresses leadership,
teamwork, and decision making skills in crisis management in addition to medical skills and knowledge.
This novel approach was codified by the Simulation Center faculty in their textbook Crisis Management
in Anesthesiology first published in 1994. Participants practice these skills in highly realistic simulations
involving complete interaction with all members of the operating room team.
    ACRM training has been offered regularly since 1990 and the Simulation Center has now made a
full three-year curriculum in ACRM with modules of increasing complexity. This training is mandatory
for anesthesiology residents in training at Stanford University and VA Palo Alto Health Care System. It
is offered to experienced anesthesiologists for Continuing Medical Education credit. The ACRM
curriculum has now been adopted at leading medical institutions in North America and in the U.K.,
Germany, Sweden, and Australia. Instructors come from all over the world to the Simulation Center at
VA Palo Alto for the ACRM Instructor Training Course.

Clinical simulation in progress. An anesthesiologist                  Defibrillation of the patient
draws up urgently needed medication while an assisting                during a cardiac arrest
colleague and the instrument nurse look on.                           scenario in the Simulation

                                             Fact Sheet

                                Simulation Center at
                           VA Palo Alto Health Care System

Simulation Center faculty have expanded the ACRM approach beyond anesthesiology to encompass
diverse medical arenas. A monthly multidisciplinary simulation course is held for the Intensive Care Unit
(ICU), including house staff, nurses, and allied health professionals. A three level sequence of CRM
courses in Emergency Medicine (EMCRM1,2,3) is conducted for interns and residents. Courses are also
run for interns in internal medicine who are about to transition to become residents, with responsibility to
run the cardiac arrest resuscitation team. Curricula for medical students are offered in anesthesiology,
intensive care, and (beginning Winter/Spring 2005) during their “Practice of Medicine” course.

                                                                Simulation Room 2 at VA Palo Alto
                                                                Health Care System, configured as an
                                                                Emergency Room for the EMCRM2
                                                                training course

The Control Room for Simulation Room 2
with a scenario in progress

   Research is an important component of
the Simulation Center’s mission.       The
Center has an extensive track record of
simulation-based research on a number of
important topics:
       • The effect of fatigue on the
           performance of anesthesiologists and other clinicians
       • The decision-making of anesthesiologists and other clinicians when managing complex
           clinical situations

                                     Fact Sheet

                        Simulation Center at
                   VA Palo Alto Health Care System
•   Human-machine interactions of anesthesiologists working with actual medical equipment
•   The feasibility of providing decision support for the ICU using artificial intelligence
•   Performance assessment of personnel by grading videotape recordings of performance in
    realistic simulations
•   The influences of personality and other psychological factors on performance


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