For more than three years, I have worked with Clinical Educators throughout OSF HealthCare to provide annual Emergency Event training through simulation to the nearly 2,000 Mission Partners at 258 multi-specialty and primary care clinic offices. Over that time, we have seen incredible advancements and have received tremendous feedback from participants involved, many of whom have even requested the inclusion of more of this type of education.
The benefit of this education program is twofold: it meets a national requirement set by the Joint Commission to conduct yearly emergency event training and, we believe, leaves a lasting impact on the teams working in our primary care clinics.
Up until 2014, these facilities received this training through a lecture didactic with associated skills station. OSF Clinical Educator Susie Watkins, however, had a better vision of how to meet this need through in-situ simulation. In-situ is a Latin phrase meaning in its original location. She believed simulation-based education would not only meet the national requirement, but also provide a rich educational experience for those employed in the offices.
Simulation Specialists at Jump are trained in running simulations, facilitation, debriefing and have backgrounds in paramedicine or nursing. Our training in the specialty of medical simulation helps us work in tandem with Clinical Educators to assess teamwork, communication skills and any knowledge gaps in care. Our clinical backgrounds help us identify opportunities to improve processes that pertain to emergency events.
As a team, our two professions come together with complementary areas of expertise that provide learners with a unique in-situ medical simulation experience. Our Clinical Educators are experts in the ambulatory setting and additionally support the program by scheduling learner groups, developing curriculum and following up on any needs discussed in debriefings.
Delivering In-Situ Education to the Masses
In-situ education can be challenging. We are without the luxury of a controlled space like the simulation lab, and in-situ simulations take place in the clinical working environment while patient care is ongoing.
Our in-situ team has developed a delivery method to enrich the simulation experience by removing any barriers. Each pre-briefing consists of a safety contract, putting the participants at ease knowing “what happens here, stays here.” We acknowledge the staff as professionals and that we understand simulation is not always true to real life.
We further articulate that we are not at their facilities to test them, but rather to invest in them and make sure they feel prepared and confident for a number of high-risk, low frequency circumstances. Our method of debriefing allows participants to share their experiences and look for opportunities of improvement, never fault finding - honoring the safety contract.
Our first pilot of this program took place in the summer of 2014 at an Eastern Region office, where we involved all employees in a simulated acute medical emergency event. Since that time, our teams have travelled to all but one region of our primary care offices within the Ministry.
What We Have Achieved
The in-situ education has helped us identify process barriers impeding Mission Partners’ abilities to respond to emergency events effectively. For example, a simulation at one location found it took 6-8 minutes per group to acquire an Automated External Defibrillator (AED). At no fault to the care team, the building’s AED was kept on the opposite side from other offices.
This clinic site was well within regulations for equipment that is required, however the simulations exposed a need to re-strategize how the AEDs were being distributed. This is a great patient safety victory by fixing a weak process that may have gone otherwise unnoticed. Preventing reactionary processes and policies are in-situ simulation’s specialty.
Beginning in 2016 we began utilizing our Standardized Participants as family members to enhance the realism of our simulations. This began to highlight the importance of our front office assistants (FOAs) through the talents and value they bring to care teams. Often these staff members are non-clinical, and most do not have a Basic Life Support or CPR certification. This occasionally leads to some participants feeling excluded, and our goal is to change that perception.
The truth is, FOAs are one of the busiest team members in many situations. They are responsible for calling 911 and they can be utilized for gathering supplies, supporting family members, being a scribe, getting responders to the appropriate location and many other supportive roles. All of these tasks allow clinicians to remain at the bedside improving patient outcomes and bettering the patient experience.
A few weeks ago, we had one of our Standardized Participants, Diane Brummitt, playing the role of a patient’s sister whose brother (SimMan3G) suddenly goes into cardiac arrest. While CPR was being performed and the care teams were preparing to defibrillate, the FOA comforting Diane asked if she would like to pray with her, and they did. The sound and sights within the simulated emergency created a very “real” feeling that gave our team goosebumps. The debriefing for this simulation left an impact that could never be duplicated from a classroom or lecture-type session.
A few days later, we revisited an office where a very excited Site Manager stated, “I am so thrilled to be doing this again. After you guys left the last time we conducted an in situ, we had a lady go unconscious requiring resuscitative efforts - and we were prepared for it.” Over the past year, the willingness to participate with enthusiasm shows the utmost professionalism among our ambulatory clinicians.
From top to bottom, we are changing the culture and professionalism of the care teams that work in our outpatient offices. We know of no other program like this that exists in the country for ambulatory care. This is our investment to serving every OSF Mission Partner, so that our patients receive the greatest care. It’s my belief that our clinics are some of the most prepared in the county.
This program is what I am most proud of with my work at Jump and I am excited to collaborate with the incredible educators, care teams and rural health care providers for several years to come.