APPLICATIONS OF SIMULATION IN

HOSPITAL

GROUP MEMBERS ROLL NO.

ASHWINI AGAVNE B-02

SNEHA DIXIT B-15

RAVI DONGRE B-16

POOJA BHADANGE B-35

TANVI PAWAR B-43

TUSHAR SADHYE B-47

SANDEEP PAWAR B-56

CHAITALI NERKAR B-57

WHAT IS SIMULATION?

Simulation is the imitation of the operation of a real-world process or system over time.

The act of simulating something first requires that a model be developed; this model represents the key characteristics or behaviors/functions of the selected physical or abstract system or process.

The model represents the system itself, whereas the simulation represents the operation of the system over time.

Why Simulation is Important?New policies, operating procedures, information flows and

son on can be explored without disrupting ongoing operation of the real system.

New hardware designs, physical layouts, transportation systems and … can be tested without committing resources for their acquisition.

Time can be compressed or expanded to allow for a speed-up or slow-down of the phenomenon( clock is self-control).

Insight can be obtained about interaction of variables and important variables to the performance.

Bottleneck analysis can be performed to discover where work in process, the system is delayed.

A simulation study can help in understanding how the system operates.

“What if” questions can be answered.

APPLICATIONS OF SIMULATION

Simulation is used in various fields, such as-Simulation of Technology for performance

optimization.Safety EngineeringTestingTraining EducationVideo gamesEntertainmentHealthcareScientific modeling of nature systems or human

systems

MEDICAL SIMULATIONMedical simulation is a branch of simulation technology related

to education and training in medical fields of various industries. It can involve simulated human patients, educational documents

with detailed simulated animations, casualty assessment in homeland security and military situations, and emergency response.

Its main purpose is to train medical professionals to reduce accidents during surgery, prescription, and general practice.

Many medical professionals are skeptical about simulation, saying that medicine, surgery, and general healing skills are too complex to simulate accurately. But technological advances in the past two decades have made it possible to simulate practices from yearly family doctor visits to complex operations such as heart surgery.

Disaster response is made easier and conducted by better trained individuals due to the rapid availability of simulators in schools, hospitals, military facilities, and research labs.

BENEFITS OF MEDICAL SIMULATION

Improving Patient Safety - The ‘Patient Safety’ issue in healthcare systems is a multi-faceted subject that is at

the top of many international healthcare agendas.

- Already identified in the US report, human factors and systems failings are some of

the recognized shortcomings that can compromise, sometimes fatally, the care of patients.

- Comparing the two industries, the healthcare and the aviation, Sir Liam Donaldson, Chief Medical Officer of England, cited in his 2009 annual report, ‘That when a person steps on a plane, their risk of dying in an air crash is 1 in 10 million. When a person is admitted into hospital, their risk of dying or being seriously harmed by a medical error is 1 in 300.” Amongst a number of recommendations to the UK government, he urged, ‘Simulation training in all its forms will be a vital part of building a safer healthcare system.’

Cont.…Transforming a ‘Team of Experts’ into an

‘Expert Team’ - Most critical medical errors occur in Acute Care where team effectiveness can be the pivotal factor that determines the outcome for the patient.

- Until now, very little training provision has existed to rehearse team effectiveness.

- Simulation addresses this training requirement in a way that no other training methodology can.

- Rare but critical and time pressured events can be recreated in a simulation, so that protocols can be established and communication problems can be identified and improved upon.

Cont.…“Hello, you’re my first patient……” – Preparing for

those First Times In the current wake of growing public awareness of medical errors and a shift in both public and professional opinion that it is no longer acceptable to practice procedures and manage clinical events for the very first time on a patient, simulation can bridge the gap between text book learning and those ‘first times’. A simulated environment is safe and risk free for trainees to build their competence and confidence.

Capturing Clinical Variation Medical simulation can capture or represent a wide variety of patient problems more readily for the learner than otherwise having to wait for a real encounter. Such simulations will give learners exposure and practical experience or rare, life threatening patient problems where the presentation frequency is low but the stakes are high.

Simulation technologies used in medical education

Computer-based simulations (micro-worlds, micro-simulation)

Virtual environments +/- hapticsPart-task trainersLow-fidelity simulators/manikinsSimulated or standardized patientsHybrid simulationsHigh-fidelity (full mission) simulation

Applications of Simulation

in Hospital

Hospitals are complex production facilities, and it requires a great perspective to consider future demands on work processes, staffing plans, optimized patient programmes, reduced waiting times, capacity changes, etc. What is the significance of variations in operation and recovery times? Is the operating budget best spent on wards, beds, porters, nurses, doctors or equipment? How are treatment procedures optimized in the best way?

The answers can be found through simulations of the clinical operation and logistics at the hospital. Simulations can clarify how to use resources optimally, and what the consequences of capacity changes, such as staff, areas and equipment, will be. At the same time, the user involvement seems more present when employees and managers can sit together and watch an outpatient department and the daily work processes in practice on the screen.

Discrete Event Simulation in Hospital Supply Chain Management

Discrete Event Simulation (DES) is used in the analysis and improvement of health-care systems.

It is particularly well suited to tackling problems in healthcare where, resources are scarce and patients arrive at irregular times (for example, in accident and emergency (A&E) departments).

Some of the applications of DES are therefore to forecast the impact of changes in patient flow, to examine resource needs (either in physical capacity of beds and equipment or in staffing), to manage patient scheduling and admissions or to investigate the complex relationships among the different model variables (for example, rate of arrivals or time spent in the system).

DES therefore allows decision makers to effectively assess the efficiency of existing healthcare delivery systems, to improve system performance or design, and to plan new ones .

BabySIMThe BabySIM is a realistic, 16 pound model of an infant with correct physiology and generated reactions to medical interventions. This simulator was created for life-saving infant care practice. "BabySIM can produce heart, bowel and breath sounds, including bilateral chest excursion and seesaw breathing.

Simulates:

-Bulging fontanel capability

-blinking eyes with variable pupil size and the ability to tear

-Cooing and crying

-Secretions from the ears, eyes, and mouth

-Responds to airway trauma or obstruction: esophageal, nasal and oral intubation, and BVM ventilation and laryngoscopic procedures

-Responds to chest compressions, defibrillation and pacing, needle decompression, chest tube insertion and intraosseous insertion

METImanThe METIman simulator is the most advanced and realistic of all CAE simulators. The METIman can withstand indoor and outside training simulations and has a large variety of training in many areas. “METIman’s easy to use learning features are designed for teaching basic nursing and prehospital skills.

Simulates:

-Suction airway secretions with variable airway resistance

-Aspirate and infuse fluids

-Cricothyrotomy/tracheostomy and bronchial occlusion

-Pacing and CPR compressions

-Responds to defibrillation

-Bilateral chest movement

-Suction airway secretions with variable airway resistance

-Palpable pulse

-Responds to needle thoracentesis and chest tube placement

CAE FidelisThis pregnant patient simulator is meant for child birthing simulations and is a Maternal Fetal Simulator. It was created for practice with normal deliveries, emergency deliveries, as well as births with complications. “Fidelis is the only childbirth simulator with validated maternal-fetal physiology. The physiological modeling allows learners to monitor and manage both patients without instructor intervention. Simulates:

-Static and dynamic cervices that dilate, efface, and station

-Fetus that automatically descends and rotates

-Fetus with soft and firm areas true to life

-Fetus that responds when stimulated with suctioning with an open mouth and nose

-Fetus with attached umbilical cord and attached placenta that is able to be positioned

PediaSimThe PediaSim was created for pediatrics in need of critical care. It is a simulation of a six-year old child. “PediaSim offers the integrated METI physiology in a smaller practice patient with full trauma features for both nursing and emergency response.” “PediaSIM HPS is specifically designed for risk-free practice of anesthesia, respiratory and critical care. With true respiratory gas exchange, PediaSIM HPS inhales oxygen and exhales CO2, interfaces with real clinical monitors and responds to oxygen therapy.

Simulates:

-Responds to clinical interventions: chest compression, pacing, defibrillation, needle decompression, and chest tube insertion

-Airway trauma features: upper airway obstruction, laryngospasm and bronchial occlusion for intubation

-BVM ventilation and needle cricothyrotomy

SimMan®3GSimMan®3G is a full size lifelike mannequin that allows for simulation of different medical conditions to help train those that would need to treat those issues in the real life. The mannequin works wirelessly and it is self-contained, allowing it to be used in realistic settings like a hospital, ambulance or military combat environment.

Simulates:

-Airway complications

-Breathing complications

-Circulation Features

-CPR

-Eye movement

-Convulsions

-Bleeding and Wounds

Simulation Projects “In the Pipeline”

Immersive Simulation for Design and Evaluation of an Emergency Department ITEmergency departments can be noisy and confusing

places where keeping track of patients can be a challenge. The goal of this project is to design and test a prototype

emergency department information system with the potential to track ED patients and improve efficiency and safety, decrease ED wait times, and decrease preventable injuries to patients.

The research team will use simulation and cognitive systems engineering methods to design and test prototype ED information systems that are based on an in-depth understanding of the activities of caregivers and staff within the ED.

They will use a multiphase strategy to model key aspects of ED activities, iteratively develop prototypes, and assess prototypes in a simulated clinical environment.

Acceleration to Expertise: Simulation as a Tool to Improve the Recognition of Sepsis

Sepsis is a diagnostic challenge and a leading cause of death worldwide.

Failure to recognize the early signs and symptoms of sepsis and institute aggressive management significantly increases the risk of death for children and adults.

Simulation-based training can accelerate the development of expertise needed by novice clinicians to quickly and accurately recognize sepsis. By identifying the unique elements of the expert's approach to sepsis, an effective, simulation-based approach might become possible. Specifically, the research team will:-

1. Determine the behaviors that characterize and differentiate the expert from the novice in the recognition of sepsis at the bedside. 2. Develop and implement simulation-based learning interventions that accelerate the development of expertise in relation to sepsis recognition.

Improving Cancer Care Patient Safety Through Pathology Training Simulation

Uncontrolled variability in diagnostic testing contributes to high rates of error and increased costs.

The incorporation of simulation training in pathology residency holds promise for reducing variability.

This research will determine whether a simulation-based anatomic pathology education combined with Lean methods of quality improvement is better than a traditional apprenticeship for reducing errors in formulating pathology diagnoses of cancer in major solid organs.

The research team will conduct a double cohort case-control study in a single institution by separating residents on the university hospital anatomic pathology rotation into two groups:

1.An integrated Lean-simulation-based anatomic pathology education track. 2.A traditional apprenticeship track. They will compare resident performance and patient safety outcomes in oncology for the two tracks over a 3-year period.

Simulation research must address healthcare training needsImproved outcomes

• Fewer adverse events, fewer preventable incidents, fewer ‘near miss’ events

Increased efficiency of training• Improved outcomes in same or (preferably) less

training timeImproved use of resources

• Fewer failures, more efficient training, quicker performance

The future of simulation...Skills training tool for all disciplines

• Acute care• Try new techniques and/or equipment• Patient safety initiatives• Retraining

Multi-disciplinary training• inter-professional communication• team performance

Training in decision-making/resource co-ordination