Every year, approximately 500,000 people in the United States experience an ST-elevation myocardial infarction (STEMI). Prompt reperfusion is essential to minimize morbidity and mortality. Most STEMI patients are initially brought to outlying hospitals and then, if appropriate, transferred to a hospital capable of performing angioplasty. A large percentage of STEMI-patient transfers take longer than the time recommended for optimal care. Timely transfers require precise teamwork and communication between EMS, Hospitals, and STEMI-care teams.
The Duke University Human Simulation and Patient Safety Center partnered with the American College of Cardiology (ACC) to deliver an in-situ simulation educational program throughout North Carolina focused on improving door-to-balloon time in STEMI care. The program, using in situ simulation, probed weaknesses in the STEMI-care chain and aimed to improve care by enhancing teamwork and communication.
This Virtual Experience is designed to educate and train users how to identify the signs and symptoms of a Stroke. During the course, students will perform a neurological assessment of the patient; through history and examination. A virtual Neuro Exam will be completed to gain an understanding of basic neuroanatomy and neurophysiology. They will be required to identify the functional areas impacted by neuroanatomy and recognize the location of neurological dysfunction. The student will also manage the patient, by developing a plan of care. Through this patient simulation, the users will gain valuable experience in diagnosing and treating a patient presenting stroke symptoms.
Patient transfers (handovers) from surgery to intensive care units (ICUs) are known to be fraught with communication and technical errors: barriers in care which multiple studies highlight a relationship between the quality of handovers and patient outcomes.
The Human Centered Design of Handovers/Virtual Handovers project aims to improve communication and decrease preventable adverse events related to OR to Neuro-ICU handovers. The project will achieve this through the development and use of a web-based, modular, multi-modal education platform which will include instructional videos and an interactive, immersive “virtual handover game.” As a modular platform, material can be added to address all types of handovers from shift-to-shift to more unit-specific processes.
The virtual handover game was developed using a human centered design: a methodology that incorporates feedback from users throughout the development process. This process allows users to shape the design product and enhance its usability, as well as allowing them to be closely involved in the refinement of their own handover process. As part of the HCD process, focus groups were conducted with key members in the neuro ICU and OR. Feedback from the focus groups were then analyzed via conventional content analysis and integrated into the educational program.
Feedback collected through the focus groups and analyzed via conventional content analysis will be integrated into a multimodal educational program including 3DiTeams (a virtual environment for learning and practice), on-site clinical observations and technology-mediated coaching. This educational program aims to improve handover quality and patient safety in critical care. The final product will be a modular program that can be expanded to address all types of handovers from shift-to-shift to more unit-specific processes (in this case OR to Neuro ICU).
After the launch of the education program, an educational research study will be conducted to evaluate the role of mentorship in the retention of teamwork behaviors.
The study aims to provide pilot data for the research hypothesis that mentoring will slow the decay of learned teamwork and communication behaviors to greater extent than self-study alone or no intervention.
Traditional approaches to training in education include classroom style delivery and workshops--known to be mostly ineffective. Virtual simulation is an alternative method of education to teach teamwork and communication skills and knowledge.
SimX leveraged our ILE@D Hemorrhage software and was introduced to staff and students at two health sites within South Australia Health and to Flinders University. The project was funded by Health Workforce Australia funded grant through the Simulated Learning Environments Program.
Postpartum Hemorrhage (PPH) is a 3D, multi-player, instructor-facilitated virtual simulation platform designed to train teams of clinicians in the medical management of postpartum hemorrhage as well as effective teamwork and communication behaviors.
Users may choose to participate in the exercise as physicians or nurses, the facilitator, or choose to be invisible as an observer. A user may even elect to be the voice of the patient.
PPH is set in a realistic virtual birthing suite where learners can freely move about and interact with the patient, equipment, supplies, and other items in the environment through an intuitive interface of on-screen buttons or item highlights. The game allows learners to perform medical procedures such as fundal massage as well as deliver routine and emergency medications and fluids.
An inter-professional team in the Human Simulation and Patient Safety Center (HSPSC) received a 1-year, $25,000 research award from the Social Entrepreneurship Accelerator at Duke (SEAD) for a project entitled “Postpartum Hemorrhage Education Via Simulation”.
The team is pioneering the use of scalable, distributable healthcare simulation using commercial game technology with a multi-player module that specifically addresses postpartum hemorrhage (PPH). As a proof-of-concept for global health, the PPH simulation software will be used to address gaps in care at Mulago International Referral Hospital in Kampala, Uganda, and to decrease disparities in healthcare education. We will host inter-professional, interactive, games-based simulation training sessions from Durham to Mulago using the Internet. This pilot program aims to reduce the incidence of postpartum hemorrhage, and to serve as a broader model for using simulation to scale education and to spread virtual learning through the developing world in resource-poor settings. Additionally, we hope to use preliminary data to support a future proposal to study the efficacy of screen-based/games-based learning in global health. Key personnel include: Jeff Taekman (MD) who is the Principal Investigator, Megan Foureman (CRNA, MSN), Amy Mauritz (MD), Adeyemi Olufolabi (MB.BS; DCH; FRCA), Michael Steele (BS) and Genevieve DeMaria (BS).
Combat Medic is an exciting new virtual educational program designed to train Army medics and other military medical personnel to manage the top causes of death in the modern battlefield: hemorrhage, airway obstruction, and tension pneumothorax (2014). Designed as a procedural trainer, the game allows medics to cognitively apply, practice, and review Tactical Combat Care, patient management, and documentation in a contextually accurate combat scenario. Combat Medic also allows for the application of other important concepts such as equipment preparation, team organization, and communication through unique and intuitive user interfaces that preserve both contextual, cognitive, and task fidelity.
Learners can either practice independently as a single player or use its multi-player function for facilitator-led and team events. Opportunities to learn reflectively is made possible with virtual pre- and post-game meeting spaces and a robust debriefing platform replete with analysis of task performance and video playback. To maximize deployability and access, the game works from browser plug-ins that are compatible with any recently produced computer.
The Pre-Deployment Anesthesia and Anaphylaxis Training System (PDAATS) -- also known as ILE@D Sedation-is a serious game designed to teach and refresh the cognitive skills of rapid sequence intubation and moderate / deep sedation to non-anesthesia providers.
This single-player, first-person simulation enables clinicians to evaluate, sedate, and medically manage ten different patients each with a unique set of medical and contextual challenges. In each scenario, learners must identify and interpret relevant findings in the patient’s background and physical exam to determine primary and secondary sedation plans.
Each patient avatar is innervated by the HumanSim physiology engine which accurately and dynamically generates heart rate, respiratory rate, blood pressure, and blood oxygen saturation depending on the learner’s actions. Cognitive fidelity is further enhanced through an innovative interface that allows learners to select medications, medication dosages, and delivery.
Following the simulation, a robust after action review (AAR) that allows players to reflectively learn from their performance.
Effective team coordination is critical for the safe delivery of care. Development of these skills requires training and practice in an interactive team-based environment. A three-dimensional serious game environment provides an engaging and cost effective alternative to other interactive training solutions such as human patient simulation. In this project we are developing a three-dimensional interactive networked system for training of military health care team coordination skills. Although this is a development project with no formal experimental hypothesis, we will conduct qualitative evaluations of the design specification and alpha and beta versions of a demonstration prototype. Ease of use, practicality, scope, and effectiveness of the training system will be assessed through heuristic analysis by experts in team training.
LE@D is a three-dimensional, collaborative world accessible from any Internet-connected computer that provides an innovative, interactive “front-end” to distance education in the health care professions. ILE@D maximizes face-to-face interactions between teachers and students through self-directed, team-based, and facilitator led preparatory activities in the virtual environment. While in the beginning phases of development, we have a grand vision for building a generic education framework which can support a variety of inter-professional healthcare training scenarios.