Photo Credit: Fanny White & OHSU

Even before the COVID-19 pandemic created barriers to in-person clinical hours and training, many universities across Oregon had trouble transitioning new healthcare providers into practice. This means that many healthcare systems across the state faced staffing shortages when the pandemic hit. In response, Oregon Health & Science University (OHSU) tasked its simulation experts early on with training and teaching their students and healthcare workers how to properly use personal protective equipment (PPE) and safely care for COVID-19 patients. Using innovative simulation tools to provide safe and effective training, OHSU helped ensure clinicians were prepared to handle the challenges created by the pandemic.

Innovating clinical training in response to COVID-19

As hospital beds across the state filled up with COVID-19 patients, so did the need for skilled nurses. However, many hospitals struggled to fill important nursing positions as COVID-19 cases increased across the state. By December 2020, according to a Fox 12 Oregon news report, “in-patient and critical care nurses [in the state] are needing to take care of double or even triple the number of patients.”

Moreover, many nurses left the workforce in 2020 due to childcare needs and burnout. Simultaneously, fewer nurses fill these positions since in-person training was canceled early on in the pandemic, delaying graduation for many nursing students.

OHSU’s simulation center quickly developed guidelines to begin safe in-person training for students and shifted efforts to train existing staff on caring for COVID-19 patients. Since many of the simulators used at the sim center, like Gaumard’s HAL, can be connected to real equipment, educators were able to train more nursing students on the use of ventilators and correct PPE use during simulated clinical scenarios.

These encounters with the simulated patients allow students to apply what they have learned in the classroom to diagnose ailments, develop a treatment plan, and collaborate with team members, as they would during clinical hours spent with real patients. This helps them practice and hone skills before they enter the workforce, helping to make their transition into the workforce easier and ensure the safety of patients.

How simulation-based training is used at OHSU

Simulation is an integral part of how OHSU students, residents, fellows, and faculty learn and train. MIRSC is one of the largest simulation centers in the U.S. and offers participants state-of-the-art simulated clinical care suites to practice patient care in the L&D, PICU, Med-Surg, and more. Each suite is stocked with real equipment and tools found in hospitals to immerse participants in the scenario.

As such, there are over 60,000 learner encounters at the simulation center each year. Using simulation-based education and training, OHSU aims to improve patient outcomes and safety by ensuring clinicians have the knowledge and skills needed to provide effective care.

“Simulation offers a safe, structured environment to learn a new skill through repeated practice until you have it nailed down,” said Donn Spight, M.D., FACS, an associate professor of surgery in the OHSU School of Medicine and associate director of OHSU Simulation.

Students can apply the skills they have learned in the classroom on simulated patients first, gain experience working with real equipment, and practice clinical skills. This means that OHSU students enter the workforce with the critical thinking, clinical reasoning, and patient care skills needed to provide safer care and ensure better patient outcomes.

Using Simulation to Prepare OHSU Clinicians for COVID Patients

In March 2020, OHSU Simulation staff shifted their focus to training clinicians and staff to provide care to COVID-19 patients. Using the mock ICU at the simulation center, educators conducted several training sessions using an artificial lung, Gaumard’s HAL patient simulator, and a Standardized Patient (SP).

OHSU Simulation staff designed the simulated training sessions to incorporate real-life support equipment and ventilators. These machines are necessary to care for certain COVID-19 patients, but they can be difficult to operate if a clinician does not have experience using them. Lack of proficiency can cause a provider to make a mistake that negatively affects the patient’s quality of care.

However, using real equipment in the simulation allows the participants to gain competency in a controlled environment before encountering real COVID-19 patients. Since the HAL simulator can be intubated and placed on a ventilator like an actual patient, participants work through an entire coronavirus case, experiencing the stress and fast pace inherent in treating these patients.

Learning is never passive in the simulation center. Participants work hands-on, using real tools to gain airway management experience, intubate patients, and work on the ventilator. Even if a mistake is made, participants receive feedback after the session to learn how to improve their performance. They then continue to practice until they develop the skills and confidence needed to avoid mistakes and provide the best care possible.

Furthermore, OHSU simulation staff designed simulation sessions to incorporate PPE use, which helps ingrain new infection control protocols in clinicians and staff. About 39% of HCWs do not remove PPE correctly, increasing the incidences of contamination for themselves and patients, so an education-based intervention like simulation training ensured OHSU clinicians were prepared for COVID-19 patients.

By incorporating infectious disease protocols into the simulation curriculum, these behaviors become second nature to the clinicians. This ensures infection protocols remain top of mind even during high-stress and fast-paced scenarios like caring for severe COVID-19 cases.

Using Simulation to Meet the Needs of COVID-19 Patients

Before the pandemic, the MRISC would train OHSU nursing students and nursing cohorts from other schools. Now, the sim center is used to help clinicians across the country and the world. For example, Albert Chi, M.D., M.S.E., an OHSU trauma surgeon, and his team developed a new low-cost, 3D printed ventilator that does not run on electricity. The ventilators can be used in COVID-19 hotspots worldwide that are experiencing a surge of patients that need to be intubated and ventilated.

Chi and his team tested the ventilator’s design on the HAL simulator because its respiratory controls allowed the team to simulate the respiratory conditions found in COVID-19 patients. Thus, Chi was able to test how well a patient responded to ventilation with his machine and make improvements to the design that would not have been obvious otherwise.

Finally, collaborating with the OHSU Department of Anesthesiology and Perioperative Medicine, the simulation center developed a video to train staff on a new, safer method for placing breathing tubes. Again, by using a simulator to test and practice the new intubation method, clinicians could intubate the patient while decreasing the risk of staff contamination from the virus.

Improving Patient Care Across the State

The COVID-19 pandemic was the first time OHSU Simulation was asked to meet an immediate and intense need. While efforts to provide proper care for COVID-19 patients continue, OHSU clinicians and staff will use the expertise gained in the simulation center to make significant contributions to patient care and provide better outcomes for patients across the state.

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