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
Medical Simulation Time Line
Aggarwal R et al. Qual Saf Health Care 2010;19:i34-i43
True interdisciplinary collaboration of physicians, scientists, engineers and educators
1960’s-1970’s
1990’s
• Resusi-Anne developed for mouth • Sim Man developed with support of the University of to mouth resuscitation training Pittsburg • University of Miami developed
2000+
• Pediasim & EC5 available
• Dramatic increases in technological Harvey: Cardiology Patient Simulator • METI brings Human Patient sophistication as market is Simulator to market establish • Rise & fall of Sim One (USC) (technology developed at the University of Florida)
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
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 Undergraduate Medical Education
Inter-professional Education
Regional
Clinics Industry Emergency Medical Service Nursing Physicians Assistant Pharmacy
GME
Research Staff PhD
UME
Residents
Medical Students M 1, 2, 3,4
Basic Skills Development
Procedural
Immersive
• • • •
• Surgical Procedures • Research • Clinical Trials
• Virtual Reality • Continuum of Care • Disaster Response
Decision Making Group Dynamics Patient Interaction General Procedures
Square Footage Requirements
Cost – Complexity – Flexibility
Health-Related Professions
Strategic Partners
Hospitals
$
Virtual/Computer
20,000
2,907
6,578
4,775
4,685
5,811
571
4,147
2,200
3,510
6,750 NSF
3,830
7,043 4,995
846
8,950 NSF
2,768
14,650 NSF
6,412
4,000
1,194
1,838
4,798
3,720
1,375
0 class size completion
Simulation
3,401
7,080 NSF
10,886
3,734
449
10,500 NSF
8,000
1,441
13,450 NSF
3,772
8,230 NSF
12,000
Clinical Skills
TOTAL AREA (NSF)
3,991
10,170 NSF
16,000
Common
18,650 NSF
n e t
s q u a r e
f e e t
Simulation Center Space Benchmarking
WMU 100 2014
Duke 100 2013
CMC 120 2011
VCU 200 2014
Stanford Emory 125 2010
150 2008
JHU 150 2006
Wash U 150 2005
Mayo 50 1999
16
# of exam rms
16
18
16
a r e a
800
# of sim rms
700
14
r o o m
13
600
12
500
10
12
12
12
12
12
10
430 NSF
400
8
6
300
6 4
200
3
3
6
6
4
4
3
130 NSF
Duke
CMC
VCU
Stanford Emory
JHU
Wash U
134
367
95
314
130
317
140
614
2
158
123
439
130
307
123
449
150
432
WMU
765
2
100
0
r o o m s
( N S F )
avg exam rm size
o f
avg sim rm size
900
ROOM SIZES & QTY
n u m b e r
Simulation Center Space Benchmarking
Mayo
0
320
1,695
1400-1,600 NSF/staff group
280
993
925
3,000
2,600 NSF/staff group
2,624
2,612
360
NSF / staff
2,400 1,800
1,628
1,417
750-1,000 NSF/staff group
793
240
965
600
s t u d e n t
200
160
0
186
-600
135
120
N S F / M S 1
1,200
s p a c e
NSF / MS1
400
NSF/MS1 & STAFF SPACE
N S F / s t a f f
Simulation Center Benchmarking
102
80
117 87
70
56
40
average benchmark range : 70-100 NSF/MS1 47
-1,200 -1,800
63
-2,400
0
-3,000
WMU
Duke
CMC
VCU
100 11
100 11
120 4
200 14
Stanford Emory 125 9
150 4
JHU
Wash U
Mayo
150 5
150 12
50 7
class size pers cap
Experiential Learning Environments: Spectrum
Task Trainers
Fundamental Skills
Case Simulation
Clinical Skills
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
Physical Diagnosis
PDx
4
25
4
0.5
small
50.0
T
6
17
1
0.5
med
8.3
1 1
MS1:Teamwork 3 hours / wk skills
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
T
6
17
4
1
med
66.7
2
skills MS2:Teamwork 4 hours / wk
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 MS3: 1.5 hours Block rotation evaluation every 6-8 wks
Prep
8
13
4
1
med & lg
50.0
Eval
1
100
1
0.5
small
50.0
Res/Sim
60
8
1
5
med & lg
40.0
?
?
?
?
med & lg
?
Surg
?
?
?
?
AH
?
?
?
?
3 Resident Resident Surg Res
Simulation Exercises*
Case Management & Teamwork# Res/Sim 2 Surgical Skills#
Allied Health Teamwork &
large room exercises#
? large
?
m e d
( a s s u m e
s t u d e n t
1 0 0
s t u
c l a s s )
u t i l i z a t i o n
Modeling Utilization 100%
17%
90% 80%
• Sim & Exam Rooms available 50% of the time • Skills Lab available 84% of the time
42%
- Design exam rooms to flex as sim rooms
70%
33%
60% 50%
84%
8%
- Design skills lab to flex as sim support (pre event breifing, debreif, etc.) - Design sim studio that can also function as a skills lab
40%
Available Capacity
30%
MS3 Demand
20%
MS2 Demand 10%
MS1 Demand
0%
12-exam rooms
3-sim rooms 1-bio skills lab
Strategic Mission & Business Plan
Critical Adjacencies PROCEDURAL SIMULATION SUITE 4,250 NSF PROCEDURE ROOM
OFFICES
CLINICAL SKILLS SUITE 2,975 NSF
SHARED 810 NSF
EX EX
PROCEDURE ROOM
CONF ROOM
OFFICES EX EX
CONTROL ROOM
EX PROCEDURE ROOM
RECEPTION
EX EX
SUPPORT WRITE-UP CORE CR
EX
OPERATING ROOM SIMULATION
SL
EX EX
DEBRIEFING ROOM
SUR. SIM. BOXES MAN. STORAGE
CLASSROOM
PR PR
SP TRAINING & FACULTY VIEWING
Case Studies
Emory University (UME) • • • • • •
User Profile Utilization Design & Layout First Cost FTE’s Operational Cost
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
FIRST COST
11,520 SIM LEARNER HOURS / YEAR 15,360 SP LEARNER HOURS / YEAR 19,200 TASK LEARNER HOURS / YEAR
3.41M $ 320 / SF
$
ANNUAL BUDGET
5K
+$
FULL TIME EMPLOYEES
7.6
REVENUE
800K 2.05M
2
1
3
.6
73K
4,865K
5,571K
SF
SF
STANDARD PATIENT
SIMULATION
EQUIPMENT COST
Clinical Skills
4685
TUITION
1
10,676 SF
1.17M
AV EQUIPMENT COST
5811 SF
SF
Simulation
Western Michigan University (Regional) • • • • • •
User Profile Utilization Design & Layout First Cost FTE’s Operational Cost
Western Michigan University Building Section
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
17,280 SIM LEARNER HOURS / YEAR 11,520 SP LEARNER HOURS / YEAR 19,200 TASK LEARNER HOURS / YEAR
4.48M $ 240 / SF
tbd
+$
FULL TIME EMPLOYEES
5.75 2
1
3
$
ANNUAL BUDGET
tbd 2.51M
10,866K
SF
1
50K
3,991 SF
SIMULATION
COMMONSPACE
EQUIPMENT COST
3991
TUITION
.75
1
REVENUE
18,650 SF
1.94M
AV EQUIPMENT COST
SF
10886 SF
3772 SF
3,772K
SF
STANDARD PATIENT
Common Clinical Skills Simulation
Duke University (Inter-Professional) • • • • • •
User Profile Utilization Design & Layout First Cost FTE’s Operational Cost
Duke University (Existing Facilities)
Duke University Building Section
Duke University Standardized Patient Exam Rooms
Duke University Simulation
Duke University Simulation Center
Durham, NC EST. 1930 NEW BUILDING 2012 CLASS SIZE 100
FIRST COST
11,520 SIM LEARNER HOURS / YEAR 9,600 SP LEARNER HOURS / YEAR 19,200 TASK LEARNER HOURS / YEAR
3.14M $ 309 / SF
tbd
+$
FULL TIME EMPLOYEES
8.7
2.5
0.2
2.0
1.0
2.0
REVENUE
$
ANNUAL BUDGET
tbd
800K
10,170 SF 4,995K
SF
SF
SIMULATION
COMMONSPACE
EQUIPMENT COST
1441
TUITION
1.0
80K
4995
1.17M
AV EQUIPMENT COST
1,441
SF
SF
3734 SF
3,734K
SF
STANDARD PATIENT
Common Clinical Skills Simulation
IPE Mission
UME Mission
3.14M
3.41M
$ 320 / SF
FIRST COST
TUITION
73K
FULL TIME EMPLOYEES
7.6
FIRST COST
800K
TBD
10,676 SF 16 Exam Rooms (140) 2000
2240
500 590 1080
3 Patient Rooms (360) 1 OR/Specialty (590) 2 Debrief (250) 2 Task/Skills (1,000)
48,000
LEARNER HOURS / YEAR
$
EQUIPMENT COST
ANNUAL BUDGET
1.17M
A / V EQUIPMENT COST
50K
5.75
800K
$
TUITION
FULL TIME EMPLOYEES
LEARNER HOURS / YEAR
EQUIPMENT COST
A / V EQUIPMENT COST
80K
$ 240 / SF
FIRST COST
40,320
2.05M 1.17M
TUITION
8.7
LEARNER HOURS / YEAR
ANNUAL BUDGET
4.48M
$ 309 / SF
FULL TIME EMPLOYEES
46,080
$
REGIONAL Mission
ANNUAL BUDGET
TBD
410 900
1150 250 1650
10 Exam Rooms (115) 2 Patient Rooms (125) 3 OR/Specialty (550) 2 Debrief (450) 1 Task/Skills (410) 2 Procedure (740)
EQUIPMENT COST
1.94M
A / V EQUIPMENT COST
18,650 SF
10,170 SF 1480
2.51M
600 1500 1050 1060
1800
2500
12 Exam Rooms (150) 10 Patient Rooms (250) 2 OR/Specialty (530) 3 Debrief (350) 2 Task/Skills (750) 2 Procedure (300)
Strategic Integration of Simulation Into the Duke Curriculum
INITIAL WORK
POTENTIAL OUTCOMES
Current Simulation Activity
Savings
Inventory of Equipment
Improved Operational Resilience
Articulated Cost
Increased Course Capacity
Delineated Funding
Improved Educational Curricula
Competitor Analysis
Expansion in Scope
SWOT Analysis
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
Tradeline Three 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
