Knowledge Management and Healthcare

Saturday, November 2, 2013, 1:30pm

Eagle General Hospital: A Simulation Lab and Clinical Learning Center

Deborah Swain


The Simulation Laboratory in the Nursing department at North Carolina Central University (NCCU) provides a vital opportunity for learning and knowledge management of health information about patient care and nursing skills. It is one of the largest hospital simulations in North Carolina and the US with over a dozen manikin patients in rooms and wards. Nursing students, faculty, and staff at NCCU are engaged in designing and implementing simulation exercises, collecting data on interactions between patients and healthcare providers, and using knowledge management to improve training and to research areas such as emergency skill responses. The Laboratory is called “Eagle General” and has robotic patients of different ages and sizes. 

The presentation to the 2013 International Conference of Knowledge Management (ICKM) will cover health informatics operations and management information for KM and Health Information Technology (HIT) practitioners. In addition a summary of on-going research and case studies about using a human patient simulator (HPS) to provide information for the analysis of healthcare quality and knowledge development will be introduced. Specifically, the research involves collecting student-nurse data for awareness building and possible knowledge tool development in the area of cardiac acute care recognition and response. Whether in an emergency department, critical care unit, or a hip-replacement patient’s room, awareness of a patient suffering from a pulmonary embolism, for example, requires a fast response. Simulator exercises may help transfer tacit knowledge through experience to student nurses. Overall, healthcare quality depends on effective training and scenarios that prepare medical professionals for challenges and the unexpected. Simulators can be used to educate students and professionals. This presentation is for both KM practitioners and researchers. 

The presentation will include a video of the facility and interviews with students and trainers. Facility management and organizational structures introducing the basics required to set up a simulation lab (how to buy, architecture required, ways to partner with NCCU and others) to enhance medical and emergency management training will also be discussed. 

RESPONSE RESEARCH Our specific research focus concerns responses to unexpected patient emergencies. For example, a patient recovering from a hip replacement may experience cardiac arrest that is unrelated to surgery or clinical admission. Can simulators be used to improve contextual awareness, alertness and response to unexpected patient behavior? We are designing “unexpected” patient situations as part of assigned classes and interviewing students (undergraduates in the nursing program) with pre- and post-tests to evaluate the impact of the exercise as well as comparing results with students who do not experience the unscheduled emergency. 

Traditionally hierarchy is basic to emergency room training. Physicians have the senior role treating patients in a high risk situation and consulting with others delegated to do actions. Simulation has been shown to be useful in preparing and training for such structured emergency environments. Current research includes study of roles and models for interactions. 

For example, in one recent Canadian study of Emergency Department (ED) and training supervised by physicians of residents and nurse practitioners, an alternative approach was tested. The physicians and their delegates were modeled as interacting pseudo-agents in a discrete event simulation (DES) using data from an Ontario hospital and compared with the traditional approach ignoring such interactions (Lim, et al, 2013). Their approach modeled a hierarchy of pseudo-agents in a simulation where pseudo-agents participants were heterogeneous and interactive entities with embedded decision logic. The pseudo-agents represented a physician and delegate, where the physician plays a senior role to the delegate (i.e. treats high acuity patients and acts as a consult for the delegate). In the hospital ED model, comparisons between the approach with interaction and without showed physician utilization increase from 23% to 41% and delegate utilization increase from 56% to 71%. This research example showed the importance of accurately modeling healthcare team relationships and the roles in which they treat patients. Neglecting relationships in emergency organizations could lead to inefficient resource allocation based on inaccurate estimates of time spent on patient-related activities and length of stay (Lim, et al, 2013). 

Our research recognizes hierarchical models, but is about emergencies outside the ED. The goal is to improve nursing education by using simulators and unexpected situations to prepare nurses for rapid response to cardiac arrest. Whether in a mock acute care facility or taking patient’s blood pressure after a routine surgery, is the nurse aware of symptoms or conditions that may suddenly appear and need immediate response (use of defibrillators or cardiac cart stimulation)? Moreover, can the nurse be trained to be more alert and sensitive to surroundings? The patient in need might be in the room but is not the patient to whom the nurse is administering medicine, for example, in a rehabilitation facility. 

In the ICKM presentation, we will share current metrics and measurements on performance based on KM of the simulated hospital or clinical environment. The pilot study results of our research on nursing students responding to simulated emergencies will be presented. 

PRESENTATION OBJECTIVES We hope the presentation will meet two objectives: (1) provide an overview of HPS labs to KM practitioners and show the health informatics potential for knowledge management in simulation centers and medical education institutions; and (2) introduce our knowledge management research that is investigating the possibility of using simulators to transfer tacit knowledge based on experience to student nurses and professional nursing practices through educational experiences that can increase the quality and safety of healthcare. Health informatics and medical training is a rich area for knowledge management research and the development of new tools. Learning requires informatics support and a KM perspective to improve patient care and prepare professional healthcare providers. 

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