2011 SUN
eLearning
eSimulation in Action
eSimulation in Action
Goal of this Interaction:
Discuss implementation and
deployment of a successful
eSimulation program leading to
improvement in efficiency, skills
retention and employee
satisfaction at MU Health Care.
eSimulation in Action
Outcomes of this interaction…
We will discuss how eLearning and eSimulation at MUHC :
Improved skills and teamwork
Increased training efficiency
Reduced costs
Trained more people in less time with fewer instructors
Improved employee satisfaction, confidence and competence
Saved lives!
eSimulation in Action
MU Health Care…
Level 1 Trauma Center for large area of Missouri-rural
Schools of Medicine, Nursing, Health Professions
Shelden Clinical Simulation Center, CED Skills Lab, SON Simulation Lab
Chest Pain Center
JC Primary Stroke Center
AHA Training Center
Missouri University Health System
In the Heart
of the
Midwest
475 beds MUHC
>500 medical staff members MUHC
1600 nurses MUHC
Includes MU Health Care, Missouri Rehabilitation Center, Women’s and
Children’s Hospital, Missouri Orthopedic Center. Missouri University Psychiatric
Center, Ellis Fischel Cancer Hospital, Internal and Outside Clinics
eSimulation in Action
Training at MU Health Care
>2100 participants trained annually for BLS
(live classes, BLS Online, BLS HC)
>900 participants trained annually for ACLS
(live classes, ACLS HC)
>450 participants trained annually for PALS
(live classes, PALS HC)
>750-1000 participants annually- Mock Code Training
>2500 participants annually Simulation Classes
eSimulation in Action
Training at MU Health Care
>80-100 participants trained annually for AACN ECCO
>500 participants trained annually for Stroke Education
>50,000 In house WBT annual training
>80,000 EMR annual training
>275 NRP training annually- online after 2011
eSimulation in Action
Training at MU Health Care
Goal is to implement and provide a
diverse number of training options for all
learning styles and work schedules, to
improve efficiency in skills training, to
improve skill retention and staff
satisfaction and to save lives.
eSimulation in Action
Approach To Training
1. Live training/traditional classroom
2. eLearning with HeartCode, BLS Online,
other self directed online learning
3. Simulation
4. Blending eLearning and eSimulation
approaches
eSimulation in Action
Live training/traditional classroom
Familiar environment, more comfortable for
some
Training costs can be higher
May improve knowledge but not necessarily
practice
Need space, instructors, time
eSimulation in Action
eLearning & eSimulation
Focus today on:
Heartcode eLearning
Mock Code eSimulation
Other simulation at MU Health Care
eSimulation in Action
eLearning with HeartCode
Self-Directed Learning
eLearning lets the participant learn at their own
pace and convenience-independently
No certified instructor needed (except PALS HC)
This is the age of technology and computers!
MU Health Care
has used some
form of eLearning
since the mid to
late 80’s. It wasn’t
called eLearning
back then, but it
was the beginning
of eLearning.
eSimulation in Action
eSimulation
Reduce errors
Improve skills
Practice in safe environment
Right patient at the right time
Learn and practice teamwork!
MU Health Care
purchased Sim
Man in 2005.
eSimulation in Action
“Having knowledgeable
instructors, computer programs
and thousands of dollars worth
of simulation equipment doesn’t
guarantee successful program
outcomes nor improve patient
outcome.”
Author Unknown
eSimulation in Action
It takes cooperation and a blended
approach to learning, using all of
the training options available.
Learn-Practice-Apply
eSimulation in Action
Top Ten Things eLearning and eSimulation Can Do:
10. decrease stress in an inherently stressful environment.
9. improve confidence.
8. improve critical thinking in a safe and controlled
environment.
7. allow participants to learn from their mistakes without
impacting patients negatively.
6. provides standard learning situations for everyone.
eSimulation in Action
5. allow learning from peers. (model behavior)
4. work on time management and priority setting.
3. allows updating of new information and technology
quickly and seamlessly.
2. bridge the student nurse, medical student, new resident,
returning to practice employee transition to the
workplace.
eSimulation in Action
And the #1 thing
eLearning and
eSimulation can do
eSimulation in Action
1. improve resuscitation, patient
care and patient outcomes!
eSimulation in Action
eLearning with HeartCode
Self-Directed Learning
HeartCode: (all AHA approved)
ACLS
BLS
PALS!
UMHC used the
Actronics system
until 2004 and
upgraded to
Heartcode ACLS.
Due to popularity,
ACLS use grew
and BLS was
added in 2008 and
PALS added this
year.
eSimulation in Action
HeartCode:
Link between “book learning” and
simulation.
Helps efficiently maintain compliance
and competence for otherwise
experienced employees that don’t
necessarily need live training to maintain
a certification.
eSimulation in Action
2 Part Process >>> course completion
Cognitive-BLS, ACLS, PALS
Skills Test with VAM- BLS, ACLS
(PALS-Live skill check with AHA PALS Instructor)
Receive Course Completion Card
(Laerdal is AHA TC and will issue BLS and ACLS
Provider cards)
eSimulation in Action
Benefits to Learner:
Self directed learning
Shorter than live class
Potential availability 24/7
Instant, objective feedback
eSimulation in Action
Benefits to Organization
Reduced costs
Clear cost structure
Consistent and standardized training
Diversifies training options
eSimulation in Action
BLS
Live BLS
Hours to
complete
3.5-4*
2.5 total* (1.5 hr
for online part,
1 hr skill check)
<1.5 hr average**
6-8
3 + 1 non-instructor
NONE
# Instructors
needed
# Participants
trained/session
BLS Online =
Skill check
BLS HC
for check in/check out
24/4 hr
(48/month)
*set up and take
down/clean up time45min- 1 hr
36/4 hr
(72/month)
*set up and take
down/clean up time45min- 1 hr
9/day
(180/month
potential)
**<10 minute clean up of
computer room
eSimulation in Action
eSimulation in Action
eSimulation in Action
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eSimulation in Action
pictures
eSimulation in Action
pictures
eSimulation in Action
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eSimulation in Action
ACLS
Hours to complete
# Instructors
needed
# Participants
trained/session
Live ACLS
ACLS HC
14-16 hrs Initial*
8-9 hrs Renewal*
6-7 hr avg
8-16 /2 day Initial class
8 Renewal class
NONE
24 Initial/month
24 Renewal/month
4/day
(208/month potential)
*set up and take down/clean up
time-2 hr
**<10 minute clean up of
computer room
eSimulation in Action
pictures
eSimulation in Action
PALS
Hours to complete
# Instructors needed
# Participants
trained/session
Live PALS
PALS HC
14-16 hrs Initial*
8-9 hrs Renewal*
6-7 hr avg (online portion )
3 hours (live skill check)
9-10 hours total
8-16 /2 day Initial class
8 Renewal class
NONE -online portion
2-3 skill check
24 Initial/month
24 Renewal/month
12/month
*set up and take down/clean up
time 2 hr
(12 participants/
1 skill check/month)
*set up and take down/clean up
time-45min- 1 hr
eSimulation in Action
HEARTCODE
THROUGH
THE
YEARS
2007
2008
2009
2010
136
BLS HC
NA
Start Nov
2008
94/yr
Jan-Sept
310
ACLS HC
PALS HC
252/yr
NA
273/ yr
NA
328/yr
NA
Jan-Sept
12
May-Sept
eSimulation in Action
Barriers to using HeartCode …
(student)
Fear of technology
Lack of team support found in live classes
Frustration
eSimulation in Action
Barriers to using HeartCode …
(institution)
Concern about quality of training
Equipment and software costs
Administration costs
eSimulation in Action
No charge to staff at MUHCoutside participants pay student cost as calculated
COSTS
Live Classes
HeartCode
Online + Skill
Check
BLS
$90/student
Cost of license
Cost of access code
no instructor costs
no instructor costs
no instructor costs
$35/student/skill check
$342/student/Initial*
$210/student/Renewal
Cost of license
NA
$342/student/Initial*
$210/student/Renewal
Cost of license
NA
$25/hour/instructor
ACLS
PALS
*includes instructor costs at
$25/hour/instructor
no instructor costs
eSimulation in Action
Additional benefits noticed at Missouri
University Health Care:
Offering multiple opportunities outside the structured
classroom
staff satisfaction!
Address all learning styles
Last minute recerts!
Critical thinking in a safe environment-teaching
environment
Can use over and over to review-”practice makes perfect”
eSimulation in Action
SIMULATION
AT
MISSOURI UNIVERSITY
HEALTH CARE
eSimulation in Action
At MUHC simulation is collaborative
effort to help provide safe and
effective patient care.
Students
New Staff
Current Staff
eSimulation in Action
Missouri University Health Care
There are multiple simulation opportunities for our
students and staff.
Center for Education and Development Skills Lab
Shelden Clinical Simulation Center
Sinclair School of Nursing Simulation Lab
Missouri University Health Care’s
Journey…
One paw print at a time
The beginning
was rough…
When Sim Man was first
purchased, he sat in Linda's
shared office for months
until they got tired tripping
over the boxes.
No space had been
designated to “keep” Sim
Man so the boxes were
moved to storage.
When finally opened he was
already due for an upgrade!
The search for a home
commenced.
eSimulation in Action
eSimulation in Action
eSimulation in Action
The first simulation course with
CEDrick was an interdisciplinary effort
to improve resuscitation.
Mock Code Monday
eSimulation in Action
Mock Code Monday
0730-0900 (46)
Interdisciplinary Mock Code practice
Internal Medicine Residents
Nursing (New and Current Staff)
Respiratory Therapists and Respiratory Therapy Students
Nursing Students
Anesthesia Residents
ACLS instructors using ACLS Scenarios
Uses simulation manikin in simulated setting
Includes debriefing
eSimulation in Action
Using Simulation for Interdisciplinary Code Blue Training: 2
Year Experience
178 ACLS Professionals -1 ½ hour of Simulated COde
Team training (SCOT)
Moderately Confident
Interpreting rhythms-35%
Follow ACLS Protocols-30%
Drug Selection-28%
eSimulation in Action
Conclusions:
Lack of confidence among certified ACLS providers.
Simulation can be used to foster interdisciplinary teamwork
and focus on common educational objectives, thereby
reducing duplication of cost and time associated with
training.
85% agreed that the simulated code training was useful
or extremely useful and would return for more training.
Poster Session Presented at IMSH 2010
eSimulation in Action
Introduction of Simulation
Trauma Nursing Update
Unit Based Mock Code
Classes
Introduction of Simulation
Partnering
Sim Center and SON
eSimulation in Action
eSimulation in Action
Just as a code team needs both skills
and teamwork to work effectively, the
different simulation centers and groups
are working together collaboratively to
meet student and staff needs.
eSimulation in Action
Purchased Mobile Unit with recording and
data collection capabilities
eSimulation in Action
Pre and Post Evaluation Data Collection
Metrics
eSimulation in Action
eSimulation in Action
2010
Mock Code Training for Women's and Children’s
Hospital (Formerly CRH)
Training for Pediatric Transport team
Training for the Helicopter Flight team
Missouri Psychiatric Center Emergency Response
training
eSimulation in Action
2010
Missouri Orthopedic Institute training for staff and
evaluation of emergency protocols
Added Simulation to New Staff Orientation
Mock Code Stroke Insitu training for evaluation of ER
and Inpatient Stroke protocols
Patient and Family Centered Care Model Videos
eSimulation in Action
Future Plans
Increasing Insitu Simulations
Increasing Simulation in New Staff Orientation
And about a MILLION other requests….
eSimulation in Action
To sum it up…
eSimulation in Action
Healthcare providers need to
respond to the changes in training
requirements, address different
learning styles, consider
challenging schedules and
workloads.
Missouri University Health Care’s
Journey…
One paw print at a time