How simulation centres help healthcare rehearse

Most industries carry out extensive testing and simulation of processes and products before releasing them to the public. Healthcare involves thorough tests of medicines, but in many cases less work has been done on processes and technology. Progress is being made, however, through the use of simulation centres – mock wards, theatres and consulting rooms where medical staff can try out new equipment and working practices, then review what went wrong and right, often with the help of video recordings. University College London Hospitals (UCLH) and Brighton and Sussex University Hospitals have a shared, camera equipped centre that has been used to improve team working for 1,500 staff. Professor Aidan Halligan, director of education for UCLH and chief of safety for Brighton and Sussex, told HC2010 in April that this has provided a significant boost for patient safety ( article ). Meanwhile, Cerner has established mocked-up wards and offices in a Paddington tower block to help NHS trusts work out how to implement the firm's Millennium software ( article ). Similarly, Norway's University of Science and Technology in Trondheim has a usability lab, where medical staff are filmed using technology. Professor Dag Svanæs told the Mobile and Wireless Healthcare conference in February that the research showed that hospitals need a range of mobile devices, and cannot simply use standard computer equipment designed for offices ( article ). Kaiser Permanente, the Californian based not for profit integrated healthcare provider, is also in on the act, using the Garfield Centre, a 37,000 square foot innovation facility in San Francisco, to test new ideas. Its director, Dr Yan Chow, says its benefits became clear when it was used by nurses to test the addition of medication carts to workstations on wheels (also known as computers on wheels or Cows). "It didn't take more than 10 minutes to find it's not going to work," says Chow, citing problems including lack of security for drugs and doctors changing their minds about what to prescribe. The centre also tests technologies through giving them the hospital equivalent of a test drive in its 'operating theatre of the future' unit. "If a vendor says something is interoperable, we get them to plug it into everything and see it's interoperable," says Chow. It makes it possible to evaluate how well equipment works with other technology, and to test it within actual processes. Kaiser has published consumer reports on the basis of such research, although it has not taken the further step of treating patients within an innovation centre (which has been done by the Mayo Clinic in Minnesota). Game on It is looking at how to train clinicians and test hi-tech equipment. Chow says there is potential in "clinical gaming" with computer game hardware, such as teaching staff how to deal with obstetrical haemorrhage, a rare but life threatening condition. Kaiser has already used a Nintendo Wii to encourage an eight year old girl to do physical therapy that she disliked. Chow was in Britain having visited South Devon Healthcare trust, which is setting up the Horizons Centre to carry out similar work. Sasha Karakusevic, director of performance and development at the trust, is looking at how the NHS deals with a fractured neck of femur, a condition often affecting the elderly which he says can involve up to 30 professionals. "It's one of the most complicated pathways going," he says. The innovation centre was opened to help test Kaiser's electronic health record system, provided by US vendor Epic, which it started installing in 2003. The organisation, which has 8.6m members, 6,000 staff and 450 locations, only recently completed the $4bn implementation project (£2.8bn at current rates). "With a very large technology project, there is only a certain pace at which you can push," says Chow. He adds that the main benefit of the Epic system is that it provides for much better data, which can be used for high quality research. The system allows members to view their records online – although Chow is very wary of the idea that they should control these records. "If you let the patient modify it, it's useless to any physician," he says. He adds that the new system's greater impact on patients has been through other features, including online appointment booking, fast communication of test results and particularly the ability to email doctors through a secure webmail system. The latter requires staff to reply within 48 hours – less in some departments. Kaiser's research suggests that this reduces the number of physical appointments in some specialities, saving money as well as patients' time, and making them more likely to continue to subscribe to the organisation – a serious consideration for US providers. It now promotes the ability to email doctors in the organisation's surgeries, and in future the online service may be expanded to suggest services patients might take up on a personalised basis, such as types of screening. Most US hospitals have thin profit margins and cannot afford work such as that done at the Garfield Centre. According to Chow: "It's too disruptive, too risky." As a relatively large not-for-profit provider, Kaiser is unusual in being able to afford this. But he adds that even if it is pricey in the short term, simulation and innovation work pays off. "Other industries have done this for years. It's really expensive to roll out products that haven't been tested," he concludes.