presents The Inter-professional Simulation Center: Opportunities, Challenges, Solutions

Presented by: Colleen O’Connor Grochowski, Ph.D

Mary Jo Olenick, AIA Sidney Ward, AIA, LEED AP

Mary Jo Olenick, AIA Principal The S/L/A/M Collaborative

Colleen O’Connor Grochowski, Ph.D Associate Dean, Curricular Affairs Duke University School of Medicine

Sidney Ward, AIA, LEED AP Principal The S/L/A/M Collaborative

Agenda • Current State of Simulation

• Planning Considerations

• Case Studies – Emory University – Western Michigan University – Duke University

• Inter Professional Education – Strategic Integration of

Simulation into the Duke Curriculum

Learning Objectives • Program and Planning

Benchmarks

• Planning a Simulation Center for Maximum Efficiency

• Cost Benefit Consideration

• Future Impacts

Current State of Simulation

Today’s Physician

Tomorrow’s Physician

Impacts on Medical Education • Halstedian approach

• Increased emphasis on patient safety • Changes in health care delivery

• Simulation

– Opportunities – Outcomes

Accreditations • Undergraduate Medical Education

– Liaison Committee for Medical Education

– United States Medical Licensing Exam Step 2CS

• Graduate Medical Education – American Council for Graduate

Medical Education

– Educational Commission for Foreign Medical Graduates

• Continuing Medical Education – American Council for Continuing

Medical Education

Expanding Role in Health Prof. Training & Certification • Regulatory Drivers

– Joint Commission documentation of improvement

• Patient Safety Drivers – Continuum of care logistics and

handoff

• Training Drivers – Procedure rehearsal – Team training – Specialty team training – Identification of knowledge into

actions – Competency-Based Education &

Assessment

SIM

Aggarwal R et al. Qual Saf Health Care 2010;19:i34-i43 Medical Simulation Time Line

1960’s-1970’s • Resusi-Anne developed for mouth

to mouth resuscitation training • University of Miami developed

Harvey: Cardiology Patient Simulator • Rise & fall of Sim One (USC)

1990’s • Sim Man developed with

support of the University of Pittsburg

• METI brings Human Patient Simulator to market (technology developed at the University of Florida)

2000+ • Pediasim & EC5 available • Dramatic increases in

technological sophistication as market is establish

John, I saved a .ppt slide of this in the folder. Maybe Tara can do a better job extracting the images. Can you get names of the 1970, 1990 and 2010 models for reference?

True interdisciplinary collaboration of physicians, scientists,

engineers and educators

Strategic Mission & Business Plan • Know the utilization by experience

– Plan for learner thru-put in order to plan for FTE support – Number of Hours Per Learner Per Year

• Critical to know FTE operational support before design • Too many have large sites unused due to lack of $$$

planning before design

Emerging Trends • Synthetic cadavers instead of

manikins

• Virtual Simulation

• Expanding standardized patient use for Nursing

• All striving to be a “Center of Excellence” in order to differentiate and be able to charge for sharing space / equipment / personnel

• Intra and Inter Professional Training

• Synthetic cadavers instead of manikins

• Expanding standardized patient use for Nursing

• All trying to be a “center of excellence” for something in order to differentiate and be able to charge for sharing space/equipment/personnel

• Intra and Inter professional training – lots of talk but few real curriculum integrations for shared experiences other than ad hoc personality driven

Duke Immersive Virtual Environment

Planning Considerations

Organic Evolution in Simulation Space Programs • Simulation Program vs. Center

• Renovation & Opportunity

• Strategic Mission & Business Plan

• Rightsizing: Aligning Program, Mission,

Budget & Facilities

• Emerging Trends

Educational Program vs. Simulation Center • Facilities grow as learner experience and desired outcomes expand

Procedural Basic Skills Development

• Decision Making • Group Dynamics • Patient Interaction • General Procedures

• Surgical Procedures • Research • Clinical Trials

Nursing

Research Staff

PhD

Residents

Medical Students M 1, 2, 3,4

Undergraduate Medical Education

Inter-professional Education

Cos

t – C

ompl

exity

– F

lexi

bilit

y

Square Footage Requirements

Regional

Immersive • Virtual Reality • Continuum of Care • Disaster Response

$

Physicians Assistant

Pharmacy

Emergency Medical Service

Industry

Clinics

UM

E G

ME

Hea

lth-R

elat

ed

Prof

essi

ons

Stra

tegi

c Pa

rtne

rs

Hospitals

class size 100 100 120 200 125 150 150 150 50 completion 2014 2013 2011 2014 2010 2008 2006 2005 1999

10,886

4,995 4,775

7,043 6,578 5,811

1,375

4,798 3,720

3,772

3,734 2,907

6,412

3,830 4,685

3,510

4,147

1,838

3,991

1,441 2,768

449

846

2,200

571

1,194

3,401

0

4,000

8,000

12,000

16,000

20,000

WMU Duke CMC VCU Stanford Emory JHU Wash U Mayo

ne

t

sq

ua

re

f

ee

t Virtual/Computer Common Clinical Skills Simulation

Simulation Center Space Benchmarking TOTAL AREA (NSF)

18

,6

50

N

SF

10

,5

00

N

SF

7,0

80

N

SF

8,9

50

N

SF

6,7

50

N

SF

14

,6

50

N

SF

13

,4

50

N

SF

8,2

30

N

SF

10

,1

70

N

SF

432

449

307

439

765

614

317

314

367

150

123

130

123

158

140

130

95

134

10

3

6 6

2

3 3

4 4

12 12 12

16

12

16

12

13

6

0

2

4

6

8

10

12

14

16

18

0

100

200

300

400

500

600

700

800

900

WMU Duke CMC VCU Stanford Emory JHU Wash U Mayo

nu

mb

er

o

f

ro

om

s

ro

om

a

re

a

(N

SF

) avg sim rm size avg exam rm size # of sim rms # of exam rms

Simulation Center Space Benchmarking ROOM SIZES & QTY

430 NSF

130 NSF

186

102 87

56

117

70

47 63

135

1,695

925

2,612

993

1,628

2,624

1,417

793 965

-3,000

-2,400

-1,800

-1,200

-600

0

600

1,200

1,800

2,400

3,000

0

40

80

120

160

200

240

280

320

360

400

WMU Duke CMC VCU Stanford Emory JHU Wash U Mayo

NS

F/

st

af

f

sp

ac

e

NS

F/

MS

1

st

ud

en

t

NSF / MS1 NSF / staff

100 100 120 200 125 150 150 150 50 class size 11 11 4 14 9 4 5 12 7 pers cap

average benchmark range : 70-100 NSF/MS1

750-1,000 NSF/staff group

1400-1,600 NSF/staff group

2,600 NSF/staff group

Simulation Center Benchmarking NSF/MS1 & STAFF SPACE

Task Trainers Fundamental Skills Case Simulation Clinical Skills

Experiential Learning Environments: Spectrum

Modeling Utilization # # Exercises/ Duration Room Hours/

Class Exercise Abr Group size Groups Week (hours) Type Week

1 Hx & Communication Hx/C 4 25 4 0.5 small 50.0

1 Physical Diagnosis PDx 4 25 4 0.5 small 50.0

1 Teamwork skills T 6 17 1 0.5 med 8.3

1 Procedures Pr 25 4 1 1 lab 4.0

1 Performance assessment Perf 1 100 1 0.5 small 50.0

2 Hx & Communication Hx/C 4 25 4 0.5 small 50.0

2 Physical Diagnosis PDx 4 25 2 1 small 50.0

2 Teamwork skills T 6 17 4 1 med 66.7

2 Procedures Pr 25 4 1 1 lab 4.0

2 Performance assessment Perf 1 100 1 0.5 small 50.0

3 Block rotation preparation Prep 8 13 4 1 med & lg 50.0

3 Block rotation evaluation Eval 1 100 1 0.5 small 50.0

Resident Simulation Exercises* Res/Sim 60 8 1 5 med & lg 40.0

Resident Case Management & Teamwork# Res/Sim 2 ? ? ? ? med & lg ?

Surg Res Surgical Skills# Surg ? ? ? ? ?

Allied HealthTeamwork & large room exercises# AH ? ? ? ? large ?

MS1: 3 hours / wk

MS2: 4 hours / wk

MS3: 1.5 hours every 6-8 wks

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

12-examrooms

3-sim rooms 1-bio skills lab

me

d

st

ud

en

t

ut

il

iz

at

io

n

(a

ss

um

e

10

0

st

u

cl

as

s)

Available Capacity

MS3 Demand

MS2 Demand

MS1 Demand

Modeling Utilization

42%

17%

84% 8%

33%

• Sim & Exam Rooms available 50% of the time

• Skills Lab available 84% of the time - Design exam rooms to flex as sim

rooms - Design skills lab to flex as sim

support (pre event breifing, debreif, etc.)

- Design sim studio that can also function as a skills lab

Strategic Mission & Business Plan

PROCEDURE ROOM

RECEPTION

CONTROL ROOM

PROCEDURE ROOM

OPERATING ROOM

SIMULATION

MAN.

OFFICES

PROCEDURE ROOM

SP TRAINING & FACULTY VIEWING

CONF ROOM

SL

SUR. SIM.

BOXES

STORAGE

DEBRIEFING ROOM

PROCEDURAL SIMULATION SUITE 4,250 NSF

CLINICAL SKILLS SUITE 2,975 NSF

SHARED 810 NSF

CLASSROOM

EX

EX

EX

EX

EX

EX

PR

PR

CR

SUPPORT WRITE-UP

CORE

OFFICES

EX

EX

EX

EX

Critical Adjacencies

Flow of Anatomy to Wet/Dry

Procedure to US/Robotics/Hapti

cs to Clinic to In Patient with

centralized shared technology control

& supply work area

Case Studies

Lab & Support 6,940

SIMULATION ROOM (in-patient) 360

SIMULATION ROOM (LDR) 360

SIMULATION ROOM (HPS) 360

SIMULATION ROOM (IR/OR) 440

SIMULATION ROOM (ED) 440

SIMULATION ROOM (ICU/PACU) 470 2,430

TASK ROOM (2 @ 300 nsf) 600

SKILLS LAB 1,400

CONTROL CENTER 250

CONTROL ROOM 70

FACULTY VIEWING ROOM 160

SCRUB SINKS 100

STORAGE 300

AV ROOM 80

LOCKER ROOMS (2) 1,300

LOUNGE 250

Debrief/Conference 2,700

DEBREIFING/CLASSROOM (40 sts) 1,600

BREAKOUT ROOMS (6 @ 150 nsf) 900

DEBRIEF STORAGE 75

TOILET (3 @ 25 nsf) 75

DEBRIEF PANTRY/KITCHEN 50

Office & Support 480

RECEPTION/WAITING 300

PRIVATE OFFICE (2 @ 90 nsf) 180

10,120

Emory University (UME) • User Profile • Utilization • Design & Layout • First Cost • FTE’s • Operational Cost

space

room area

(NSF)

area

subtotal

(NSF)

Lab & Support 3,855

SIMULATION OR 578

SIMULATION ER 730

SIMULATION ER 384

SIMULATION LAB SUPPORT 1,142

MASTER CONTROL ROOM 385

STORAGE 497

SCRUB 139

Office & Support 343

OFFICE 122

OFFICE 118

RECEPTION 104

Study 1,582

GROUP DISCUSSION 234

GROUP DISCUSSION 245

WORK AREA 1,103

5,780

NSF # Rms Lv. Total NSF

Clinical Skills AreaStandardized Patient (SP) Suite

Large SP Exam w/ Observ. Window 140 16 3 2,240AV Control 123 2 3 246Patient Lounge 237 1 3 237Student Write-up/ Group Area 429 4 3 1,716

SP Suite OfficesCoordinator 123 1 3 123Assist. Coordinator 123 1 3 123

Subtotal: Clinical Skills Area 4,685

Simulation Lab SuiteSimulation Workarea 1,103 1 B 1,103Simulation OR 590 1 B 590Master Control Room/Tech Space (per Waveguide)383 1 B 383Medical Supply/Storage 500 1 B 500Debriefing Room 250 2 B 500Reception 100 1 B 100Simulation ER 730 1 B 730Simulation Patient Room 384 1 B 384Scrub 139 1 B 139Task Trainers 1,142 1 B 1,142

Subtotal: Teaching Laboratories 5,571

Total 10,256

Emory University Building Section SID

Emory University Simulation Center

Emory University Beneficial Adjacencies

Emory University Simulation Center

GROUND FLOOR

Emory University Standardized Patient/Clinical Skills Lab

Emory University Computer Classrooms

Emory University Standardized Patient/Clinical Skills Lab

Atlanta, GA EST. 1854 NEW BUILDING 2007 CLASS SIZE 138-150

11,520 SIM LEARNER HOURS / YEAR 15,360 SP LEARNER HOURS / YEAR 19,200 TASK LEARNER HOURS / YEAR

FIRST COST

3.41M $ 320 / SF $

ANNUAL BUDGET

800K FULL TIME EMPLOYEES

7.6

1 2 1 3 .6

10,676 SF

2.05M EQUIPMENT COST

+$ REVENUE

5K

73K

TUITION

SF 5,571K

SIMULATION

SF 4,865K

STANDARD PATIENT

4685 5811

Clinical Skills

SimulationSF SF

AV EQUIPMENT COST

1.17M

Western Michigan University (Regional) • User Profile • Utilization • Design & Layout • First Cost • FTE’s • Operational Cost

Lab & Support 6,940

SIMULATION ROOM (in-patient) 360

SIMULATION ROOM (LDR) 360

SIMULATION ROOM (HPS) 360

SIMULATION ROOM (IR/OR) 440

SIMULATION ROOM (ED) 440

SIMULATION ROOM (ICU/PACU) 470 2,430

TASK ROOM (2 @ 300 nsf) 600

SKILLS LAB 1,400

CONTROL CENTER 250

CONTROL ROOM 70

FACULTY VIEWING ROOM 160

SCRUB SINKS 100

STORAGE 300

AV ROOM 80

LOCKER ROOMS (2) 1,300

LOUNGE 250

Debrief/Conference 2,700

DEBREIFING/CLASSROOM (40 sts) 1,600

BREAKOUT ROOMS (6 @ 150 nsf) 900

DEBRIEF STORAGE 75

TOILET (3 @ 25 nsf) 75

DEBRIEF PANTRY/KITCHEN 50

Office & Support 480

RECEPTION/WAITING 300

PRIVATE OFFICE (2 @ 90 nsf) 180

10,120

NSF # Rms Lv. Total NSF

Clinical Skills AreaStandardized Patient (SP) Suite

Large SP Exam w/ Observ. Window 140 16 3 2,240AV Control 123 2 3 246Patient Lounge 237 1 3 237Student Write-up/ Group Area 429 4 3 1,716

SP Suite OfficesCoordinator 123 1 3 123Assist. Coordinator 123 1 3 123

Subtotal: Clinical Skills Area 4,685

Simulation Lab SuiteSimulation Workarea 1,103 1 B 1,103Simulation OR 590 1 B 590Master Control Room/Tech Space (per Waveguide)383 1 B 383Medical Supply/Storage 500 1 B 500Debriefing Room 250 2 B 500Reception 100 1 B 100Simulation ER 730 1 B 730Simulation Patient Room 384 1 B 384Scrub 139 1 B 139Task Trainers 1,142 1 B 1,142

Subtotal: Teaching Laboratories 5,571

Total 10,256

SID UPDATING

Western Michigan University Building Section SID

Western Michigan University Simulation

Western Michigan University Standardized Patient

Western Michigan University Clinical Skills

Western Michigan University Simulation Center

Kalamazoo, MI EST. 2014 NEW BUILDING 2014 CLASS SIZE 50 – 80

FIRST COST

4.48M $ 240 / SF $

ANNUAL BUDGET

tbd FULL TIME EMPLOYEES

5.75

1 2 1 3 1 .75

2.51M EQUIPMENT COST

+$ REVENUE

tbd

50K

TUITION

18,650 SF

SF 10,866K

SIMULATION SF 3,772K

STANDARD PATIENT

3,991 COMMONSPACE

SF

3991

3772 10886

Common

Clinical Skills

SimulationSF SF

SF

AV EQUIPMENT COST

1.94M

17,280 SIM LEARNER HOURS / YEAR 11,520 SP LEARNER HOURS / YEAR 19,200 TASK LEARNER HOURS / YEAR

Duke University (Inter-Professional) • User Profile • Utilization • Design & Layout • First Cost • FTE’s • Operational Cost

NSF # Rms Lv. Total NSF

Clinical Skills AreaStandardized Patient (SP) Suite

Large SP Exam w/ Observ. Window 140 16 3 2,240AV Control 123 2 3 246Patient Lounge 237 1 3 237Student Write-up/ Group Area 429 4 3 1,716

SP Suite OfficesCoordinator 123 1 3 123Assist. Coordinator 123 1 3 123

Subtotal: Clinical Skills Area 4,685

Simulation Lab SuiteSimulation Workarea 1,103 1 B 1,103Simulation OR 590 1 B 590Master Control Room/Tech Space (per Waveguide)383 1 B 383Medical Supply/Storage 500 1 B 500Debriefing Room 250 2 B 500Reception 100 1 B 100Simulation ER 730 1 B 730Simulation Patient Room 384 1 B 384Scrub 139 1 B 139Task Trainers 1,142 1 B 1,142

Subtotal: Teaching Laboratories 5,571

Total 10,256

SID UPDATING

Duke University (Existing Facilities)

Duke University Building Section

Duke University Standardized Patient Exam Rooms

Duke University Simulation

Duke University Simulation Center

Duke University Simulation Center

EST. 1930 Durham, NC

NEW BUILDING 2012 CLASS SIZE 100

FIRST COST

3.14M $ 309 / SF $

ANNUAL BUDGET

tbd FULL TIME EMPLOYEES

8.7

2.5 0.2 2.0 1.0 2.0 1.0

800K EQUIPMENT COST

+$ REVENUE

tbd

80K

TUITION

10,170 SF

SF 4,995K

SIMULATION SF 3,734K

STANDARD PATIENT

1,441 COMMONSPACE

SF

1441

3734

4995

Common

Clinical Skills

Simulation

SF

SF

SF

AV EQUIPMENT COST

1.17M

11,520 SIM LEARNER HOURS / YEAR 9,600 SP LEARNER HOURS / YEAR 19,200 TASK LEARNER HOURS / YEAR

FIRST COST

3.41M $ 320 / SF

46,080 LEARNER HOURS / YEAR

$ ANNUAL BUDGET

800K

F U L L T I M E EMPLOYEES

7.6

10,676 SF

2.05M EQUIPMENT COST

73K

TUITION

2240

1080 590 500

2000

16 Exam Rooms (140)3 Patient Rooms (360)1 OR/Specialty (590)2 Debrief (250)2 Task/Skills (1,000)

A / V EQUIPMENT COST

1.17M

UME Mission

FIRST COST

3.14M $ 309 / SF

40,320 LEARNER HOURS / YEAR

$ ANNUAL BUDGET

TBD

F U L L T I M E EMPLOYEES

8.7

10,170 SF

800K EQUIPMENT COST

80K

TUITION

1150

250

1650 900

410

1480 10 Exam Rooms (115)2 Patient Rooms (125)3 OR/Specialty (550)2 Debrief (450)1 Task/Skills (410)2 Procedure (740)

A / V EQUIPMENT COST

1.17M

IPE Mission

FIRST COST

4.48M $ 240 / SF

48,000 LEARNER HOURS / YEAR

$ ANNUAL BUDGET

TBD

F U L L T I M E EMPLOYEES

5.75

18,650 SF

50K

TUITION

A / V EQUIPMENT COST

1.94M

REGIONAL Mission

1800

2500 1060

1050

1500 600 12 Exam Rooms (150)

10 Patient Rooms (250)2 OR/Specialty (530)3 Debrief (350)2 Task/Skills (750)2 Procedure (300)

2.51M EQUIPMENT COST

Strategic Integration of Simulation Into the Duke Curriculum

” “

DukeSim

DukeSim is an institutional-level program that is led by and works collaboratively with Duke simulation leaders

to coordinate efforts, improve efficiency, identify and develop inter-center simulation projects, and maximize the overall value of simulation to improve education,

research, and quality of care throughout Duke Medicine.

INITIAL WORK

Current Simulation Activity

Inventory of Equipment

Articulated Cost

Delineated Funding

Competitor Analysis

SWOT Analysis

POTENTIAL OUTCOMES

Savings

Improved Operational Resilience

Increased Course Capacity

Improved Educational Curricula

Expansion in Scope

Innovation

Identifying Target User Group(s) • School of Medicine Faculty

and Students • School of Nursing Faculty

and Students • Residents –

Anesthesiology, Surgery • Durham VA Faculty • Duke Hospital Employees

Inter-Professional Education • Organized Implementation of Inter-Professional & System Wide

Ventures – Code Team Training – Trauma Management – Obstetric Hemorrhage Response – Disaster Planning

• 3DiTeams • ILE@D • Inter-professional student clinic

“there is a need for stakeholders to function as a unified team to achieve common vision and goals.”

Research • Quality • Patient Safety • Applied Informatics • Human Factors • Teamwork • Communication • Education • Leadership

1. Your simulation center will never be a profit center

2. Medical student education needs will drive the space program and design but creative strategies can improve utilization (and generate income) • Interprofessional programs • Professional development programs • Industrial partnerships • Research

3. Consolidated simulation centers deliver the highest value • Shared functions and flexible/

adaptable spaces = reduced footprint = reduced first cost

• Staffing efficiencies impact operating cost

Tradeline Three