Marshall (Mark) Smith, MD, PhD Banner Health We exist to make a difference in people's lives through excellent patient care. Marshall (Mark) Smith, MD, PhD Carol Cheney, MS

Banner Health One of largest, nonprofit healthcare systems in US Over 30,000 employees and 3060 licensed beds One hospitalized patient in 200 in US at Banner in the US is in a Banner facility

Banner Simulation System Improving patient care through simulation, learning and education

To Err Is Human: Building a Safer Health System Institute of Medicine 1999

– Crossing the Quality Chasm, IOM, 2001 “The current care system cannot do the job. Trying harder will not work. Changing systems of care will.” – Crossing the Quality Chasm, IOM, 2001

Simulation Training Ability to practice, and make mistakes, in a consequence free environment Ability to objectively measure psychomotor and cognitive skills

Banner Simulation Medical Center Improving patient care through simulation, learning and research…

Doctor and Patient Practicing on Patients, Real and Otherwise By PAULINE W. CHEN, M.D. Published: January 28, 2010 Banner Health, a nonprofit system that just opened a 55,000-square-foot simulation training center in Arizona, the largest of its kind in the United States.

55,000 sq ft center 55 bed virtual hospital simulation learning center Will eventually train all disciplines/specialties

55 bed virtual hospital Emergency department Intensive care unit Neonatal ICU Pediatric ICU General pediatrics Lecture classrooms Skill stations Medical surgical floor Labor and delivery suite Operating room suite Standardized patients

Skill Simulator Training in Aviation

C VC Placement EVERY entering new resident since 2006 has passed the CVC course before seeing a patient

92% decrease in pneumothorax 83% decrease in infections One billion in cost of complications of CVCs per year Cost of complication for CVC is ~ $20,000 to 25,000 / line 5,000,000 placed in US / yr Thus, 25,000 at Banner per year 15% complication rate = 3,500 comps / yr Cost to Banner of CVC comps =

ACLS Training

Revision of Traditional ACLS Training Course Weighted Checklists Train to errors High fidelity simulation

increases learning by 300%

Evaluation Systems

Evaluation Systems

Warm Up in Surgery

Nintendo Wii Gaming extensions to Wii can be modified for surgical instruments. Wii Mote

Full System in Action

Wii and Rehabilitation

Nursing Onboarding Highest rate of attrition is in 1st yr New nurses are overwhelmed when placed into patient care Many individual systems that provide varying bridge training for nurses from graduation to independent care of patients Very significant costs to institutions Length varies from 3 to 12 months Unlike physician residencies and fellowships, there is no standardization as to curricula or length of program

Our Mission Standardized simulation curricula with: Validated adult learning techniques Objective measurements of competencies!

Goals Standardize training across Banner Competency based rather than time Decrease onboarding time required Increase retention of new nurses Reduce errors in patient care Many individual systems that provide varying bridge training for nurses from graduation to independent care of patients Very significant costs to institutions Length varies from 3 to 12 months Unlike physician residencies and fellowships, there is no standardization as to curricula or length of program

New Employee Orientation On-Boarding Pathway Unit Preceptorship Simulation New Employee Orientation (Skills and Scenarios Clinical New Employee Orientation 2 days to 11 total weeks DOE NEO Professional Development Clinical Academies 1 day at facility 3-4 days at facility Started at month 3 after hire 10 (4) hour sessions Completed at 1 year 5 days over 2 weeks if new grad 4 days if new to service 1.5 days if experienced Up to 3 months if new to service (Peri-Op 6 months) Ongoing continuing education, CE direct, BLC, Learning and Development, etc…

Teamwork

Research and Learning Initiatives Qualities of Teamwork Communication Leadership Mutual Support Situation Monitoring

Clinical Excellence Clinical education and simulation technologies Cognitive learning and critical decision making Team training and communication skills Maintenance of provider clinical proficiencies Errors reduction in delivery of patient care Peer review (OPPE) and evaluation of competencies Evaluation of new delivery models for clinical care

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