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In an environment where it's safe to make mistakes, staff build competency, sharpen critical thinking skills

It was supposed to be a routine procedure to remove the sheath a cardiologist had used to thread a catheter to a patient's heart. But as the tubing was being pulled the patient reported feeling light-headed and the bedside monitors showed her blood pressure and heart rate were dropping.

SSM Health nurses Megan McBride, center rear, and Haley Reyland respond to a simulated emergency at the SSM Health Training and Simulation Center near Fenton, Mo. Nursing trainer Dianne Herbst, right foreground, instructs them on proper procedures to stabilize a patient encountering complications following a cardiac catheterization. Photo by Sid Hastings/© CHA

The five nurses who ringed the bed talked through their response and their interventions, which included administering Atropine to speed up the heart rate and using a femoral compression device to stop the bleeding from the sheath site. Within minutes, the patient's vital signs were rebounding, and the crisis was over.

The fact that the emergency was only a simulated one using a lifelike, high-fidelity manikin that was under the command of human operators in a nearby control room didn't mean that it wasn't stressful, said Haley Reyland, one of the nurses who took part in the training.

The nurses were randomly matched up for the simulation that was the second part of a two-day session for about 20 nurses from SSM Health hospitals across the St. Louis region. The session focused on managing the care of cardiac patients, including through the use of telemetry equipment.

The first day of training was earlier in the week and done in a classroom. All of the training was held at the SSM Health Training and Simulation Center that opened in June near Fenton, Mo.

"It can be really nerve-racking as a nurse because you know you're being video recorded and watched," Reyland said of the simulation training. "But in the end, it's a great way to practice those real-life scenarios without any of the bad consequences." Reyland is an RN at SSM Health St. Joseph Hospital –St. Charles in St. Charles, Mo.

Close to reality
That's the type of response that educators at the training center said they were hoping to get.

Dianne Herbst, who was among the trainers in the session that Reyland was part of, sees the simulation training as invaluable because it so closely mimics the situations that nurses actually face.

"I think this is how nurses learn and how they will remember these things," said Herbst, who is manager of clinical education at SSM Health's St. Joseph hospitals in St. Charles, Lake St. Louis and Wentzville, Mo.

After the telemetry simulation, the nurses took part in a debriefing on the emergency and their response in a conference room where they could watch a playback of their performance on a large video screen.

SSM Health training supervisor Beth Moore, right, watches through an observation window as SSM nurses work with a high-fidelity manikin simulating a serious drop in blood pressure and heart rate following an invasive cardiac procedure. As part of the clinical training exercise, the nurses will gather for a debriefing to review a video of their response and discuss challenges. Photo by Sid Hastings/© CHA

That conference room is just across from where the telemetry training took place in what looked like a typical patient room. Next to the patient room is a mock emergency room where wheeled cots and examination tools are separated by curtains. Down the hall, another room is outfitted like a modern birthing suite.

Spectrum of care
The simulation center is meant to reflect a broad section of hospital and at-home care. And, consequently, the training provided there is meant to cover the best treatment practices under a gamut of expected and unexpected patient scenarios.

"The hope is that it leads to better care," said Dr. Guy Venezia, medical director for obstetrics at SSM Health St. Clare Hospital – Fenton, part of the team that created the simulation center to provide realistic training to doctors and nurses in all specialties.

Venezia

Venezia is sold on the effectiveness of simulation training. Such training has been required for SSM Health pediatricians and obstetricians for about 10 years and Venezia is convinced it has improved patient outcomes.

A review of simulation studies published by Academic Medicine in November 2015 supports this. The studies reported improvements after simulation-based mastery learning in several areas, including procedure performance, task success, patient discomfort, procedure time and complication rates.

As part of the training for obstetricians and obstetrics nurses at the simulation center, Venezia said they work on mastering the medical protocols for emergencies known to lead to high maternal morbidity and mortality. They include protocols for preeclampsia, shoulder dystocia, cardiac arrest, postpartum hemorrhage and emergency C-section.

Wood

"We run through those so that our nurses and physicians have the experience of the highest-risk patients and of how to effectively manage those in real time," Venezia said.

The OB trainings make use of a birthing mother and infant manikins.

Support staff training
SSM Health's training center, which in addition to the simulation rooms includes classrooms and the conference room, fills the second floor of a 55,000-square-foot building just across Highway 141 from SSM Health St. Clare Hospital. The building once housed a now-defunct business college. SSM Health invested $2.5 million in the simulation and training center.

Initially, the center is being used to train doctors and nurses from the health system's eight hospitals in the St. Louis area.

Amber Wood, SSM Health's system director for learning and development, said the eventual goal is to use the simulation center to train the entire SSM Health workforce at those hospitals, including workers who aren't in direct care roles, such as people who check in patients and environmental service workers.

SSM Health nursing trainer Kayla Yost, right, works with nurses Kirsten Settle, left, and Brooke Glore as they perform CPR on a medical manikin at the SSM Health Training and Simulation Center. SSM Health invested $2.5 million in the center, which opened in June. Photo by Sid Hastings/© CHA

The center's training will reach across SSM Health's four-state system. Staff at hospitals in Wisconsin, Oklahoma, Illinois and other Missouri markets are able to tune in remotely for live demonstrations of new practices and protocols, Wood said, and they will be doing their own simulations based on the curriculums and protocols developed at the simulation center.

Sharing best practices
Wood also had a lead role in establishing the simulation center and sees the training provided there as a means to instill best practices systemwide.

In addition to the mock ER, patient room and birthing suite, the simulation center has a pediatric examination room and an apartment-like section with a kitchen, living room, bedroom and bathroom so providers can train on home health care practices with actors brought in to pose as patients.

Mental health training will probably start later this year and it also will involve the use of actors. Clinicians caring for that population would get training on a range of scenarios, such as how to de-escalate situations in a behavioral care setting.

Herbst said that while simulation is not new in medical training, the center's high-tech tools and realistic settings has allowed SSM Health to take its training to another level. The simulations are so lifelike that they give the trainees a chance to polish the teamwork and communication skills that are essential in clinical settings.

"The facility is just like what we're used to," Herbst said. "This is what the units are like where we work and so the nurses can really immerse themselves in the situations."