Utilizing a Managed Services approach helped Boys Town National Research Hospital overcome barriers to meeting their simulation goals.

In 2019, a new Pediatric Intensive Care Unit (PICU) was established at BTNRH. Dr. Mohan Mysore, M.D., FAAP, FCCM, Medical Director of the PICU, and Karen Conboy, BSN, RN, CCRN, Director of the PICU, are among the members of the new team who were brought on board. Being familiar with the value of simulation in preparing providers to deliver optimal care, Dr. Mysore and Karen immediately identified the importance of introducing high-quality simulations to staff at BTNRH. 
 
They wanted to provide meaningful and realistic in-situ simulations of patient cases applicable to the daily clinical work in the various areas of the hospitals to ultimately improve knowledge of and competencies within clinical assessment, early recognition, and intervention in the acutely deteriorating patient.

"Conducting these advanced simulation scenarios [allows] for expansion in staff knowledge base in assessment skills, early recognition of decompensation, staff roles, and interventions during a medical emergency. Developing muscle memory through participation in realistic simulation sessions has been shown to improve team function and patient outcomes in real-life clinical settings."

- Dr. Mohan Mysore, M.D., FAAP, FCCM
Director of the Advanced Care Unit, Boys Town National Research Hospital

After careful consideration, it was determined that establishing a simulation center at BTNRH was not feasible for several reasons, including:

• Due to the wide age range of the patient population served as well as the highly specialized services offered, a simulation center would have to be equipped with simulators ranging from infant to adult. The considerable capital cost to purchase simulators and required equipment was outside their budget.
  
  
• They lacked enough space to permanently dedicate to a simulation center.
  
  
• Establishing a simulation center would require them to hire educators and operators, as only a few members of the staff had significant experience with high-fidelity simulation.
  
  
• There was some hesitation to establish a simulation center due to the high proportion of staff who had no experience with high-fidelity simulation – so they had yet to see the value in it. Some staff were concerned about simulation taking time away from clinical care to attend training sessions.

Faced with struggles of budget, space, lack of staff, and staff hesitance, Karen and Dr. Mysore decided to try a different approach. In 2021, they decided to partner with Laerdal, who could help them overcome these barriers through a Managed Services approach.

As part of its Managed Services program, a Laerdal team would come to BTNRH and bring the simulators and operators needed to conduct the specific scenarios that Karen and Dr. Mysore wished to run. The team would take care of setting up and breaking down the equipment, allowing Karen and Dr. Mysore to focus completely on education.

Using the Managed Services program, Karen and Dr. Mysore were able to successfully surpass the hurdles they were experiencing and move forward with pursuing their simulation training goals.

Ultimately, utilizing Laerdal’s Managed Services allowed them to:

• Expose hesitant staff to simulation to illustrate its value in preparing staff for pediatric emergencies
  
  
• Eliminate the need for space at their facility for storing and maintaining equipment
  
  
• Avoid the need for any capital outlay for simulation equipment
  
  
• Avoid the need to train staff to program and operate simulators, allowing their educators to focus on facilitating and debriefing
  
  

"Having [the Laerdal] team come in … to execute [the scenarios] so that we can free up our educators or physicians that are helping moderate these engagements to really focus on the team instead of focusing on the equipment and manikins. … that was just something that was very beneficial to being a growing program in a smaller facility."

- Karen Conboy, BSN, RN, CCRN
Director of the PICU, Boys Town National Research Hospital

Additionally, choosing Managed Services allowed them significant flexibility in tailoring their in-situ simulations throughout the hospital. The additional support allowed them to more easily modify scenarios and learning objectives in areas from med-surg to the PICU and surgery center.

Since the initial engagement in 2021, Laerdal has returned to BTNRH for a series of trainings focused on areas/scenarios including anaphylaxis, septic shock, respiratory distress/failure, and malignant hyperthermia.

Karen and Dr. Mysore agree that one of the most important results of their simulations has been improved teamwork.

“It’s definitely team-building – working together in a team environment,” says Karen. “Everyone needs to be able to know their roles in these situations.”

“Prior to our arrival here in 2019, the whole concept of critical care was not really something that was established,” explains Dr. Mysore. “The simulations allowed us to build those bridges between the critical care team and other areas with varied skill sets and varied exposure to simulation … and it also helped us bring those teams’ diverse experiences together to speak a common language.”

The simulations did not just provide training for the staff but also uncovered opportunities for improvement in clinical processes.

Some of these areas include:

Karen and Dr. Mysore have carefully tracked staff reception of the simulation experiences over time through pre- and post-simulation surveys. The data has consistently reflected that the simulations are both effective and widely well-received by staff.

Reviewing staff comments and feedback provided from open-ended survey questions has allowed the simulation team to reflect on staff perceptions and take into consideration this feedback for improving future simulation trainings. 
 
“The simulations are great learning experiences,” one participant commented after an anaphylaxis scenario. “I think this was very beneficial,” another learner agreed. After completing a LAST scenario, one participant noted that it was “great to run through this type of scenario and help bring awareness to the staff!” while another participant said that it was a “helpful, non-intimidating environment.” 

Now, three years into their partnership with Laerdal, BTNRH is planning the content for additional trainings into 2024. They intend to continue using simulation to drive ongoing improvement efforts and ensure that their staff are fully prepared to provide the best possible care for every patient.

Let’s talk about how a Managed Services approach can help you overcome challenges to reaching your simulation goals