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Simulation suite success

Posted: 17 December 2019

Picture of a staff with manakins

Immersive clinical role-play designed to improve patient safety

-“It gave me the chance to experience a high-pressure situation in a controlled environment before experiencing it in real life.” FY1/2 Doctor

- “I feel more confident working with multidisciplinary teams and in the delivery of my care of acutely ill patients.” Student Nurse

- “Genuinely excellent day; very realistic and useful.” UCL Medical Student

West Hertfordshire Hospitals NHS Trust (WHHT)’s interactive simulation suite has played host to 1,182 staff and students, training in mock clinical scenarios this year.

Up to five departmental learning sessions take place weekly and many are based on common acute clinical presentations, never-events and potentially preventable serious-incidents.

The suite offers three rooms; the simulation suite (a mock-up of a hospital ward), the control room (or backstage) where the voiceover and response to telephone calls are handled, and the debrief room where the analysis takes place.

The mock ward is fully kitted out with equipment including crash trolleys, working anaesthetic machines and an intensive care ventilator. Realistic ward sounds are pumped through the radio and manakins are doused in scent, according to the medical issue they present with, e.g. pear drop food flavouring to simulate diabetic ketoacidosis.

The three-strong staff who run the simulations; Simulation Technician Mary Holding, Simulation Manager Bruce Kerr and Clinical Director Ratna Makker, ensure the experience is totally immersive and realistic. They take turns to playact family members, provide convincing voiceovers through the manakins, and ensure special effects are credible.

Simulation Technician Mary Holding is studying an M.Sc. in Health and Medical Simulation at the University of Hertfordshire, funded by the Trust.

Picture of nursesShe said: “We do go above and beyond in making the simulation as realistic as possible. In one scenario I remember using face paints on our child manakin and dipping a children’s jumper in a puddle, so it was drenched in mud to bring the simulation to life."

If a department is interested in writing a scenario they are provided with a template and support. The writing process encourages staff to air concerns which is particularly helpful when learning from serious incidents.

There is also a bank of standard scenarios including anaphylaxis, stroke, sepsis, haemorrhaging and cardiac arrest which have been written by members of West Herts Initiative in Simulation, Education and Research Faculty (WISER) which is made up of a panel of representatives from each department.

The simulation team also offers virtual reality simulations using specialist headset equipment funded by Health Education England, East of England.

The suite currently homes its own simulation family of manakins including:

- Roger, an older chap who breathes and has pulses for patient observations

- Cedric can simulate tears and sweat and display a wide range of physiological and neurological symptoms as well as pharmacological responses for over 145 drugs

- Daisy is a new-born tether less simulator designed for neonatal resuscitation and can breathe and move

- Baby Archie, Bertie the toddler and Deeba the 8-10-year-old are mainly used for Children’s Emergency Department and On Call Paediatric Physio scenarios. They are hyper- realistic and can be intubated, ventilated, can receive CPR and have intraosseous access.

Coming Soon is Edith a geriatric lady manakin who can receive an intraosseous infusion, has removable, closable eyelids, changing pupils and a removable wig. She will be used for palliative care and cancer scenarios.

Also – on her way and funded by Pals and League of friends, is Lucina, a pregnant lady manakin who shows contractions and actually gives birth.

Simulation Manager Bruce Kerr said: “We know simulation works as an educational tool, based on extensive research.

“You could be tricked into thinking that the learning happens in the simulation suite where the teams spend up to 20 minutes at a time, but the real learning happens in the debrief which is three times as long. All feedback is tailored to each individual trainee, focusing on their strengths and areas for improvement. We have an extremely high standard of debrief training because we want our education to be the best.”

Picture of nurses looking at x-rayInternal Medicine Trainee, at Watford General Hospital’s Intensive Care Unit, Dmitriy Chernov trained in the suite, he said: "Simulation is a very powerful learning tool that provides junior doctors with a safe and protected environment where they can hone and develop their skills without compromising patient care. It was an invaluable addition to my foundation training.

“The sessions helped me to become more confident in managing acutely deteriorating patients on the ward which was particularly useful during busy evening and night on-call shifts where the foundation doctor is usually the first point of call for unstable patients. “


Notes to editors

  1. For more information, please contact the communications team on: 01923 436280 or email: Out of hours, please call 07900 228031.
  2. WeWest Hertfordshire Hospitals NHS Trust serves people from across Hertfordshire, north London and further afield. It operates from three hospitals; Watford General, St Albans City and Hemel Hempstead. The trust has a catchment area of over 500,000 people and is one of the largest employers locally, with around 5,000 staff and volunteers.
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