May 13, 2022
Is it a bird? A plane? A mobile simulation bus? Mobile simulation, which brings vehicles equipped with spaces to simulate patient care areas, task trainers, and mannequins directly to the health care provider, has steadily increased over the last decade. Since 2007, the Children’s Minnesota Mobile Simulation Center Bus has traveled to provide hands-on practice for health care professionals across the region. The Mobile Simulation Center is a 40-foot RV outfitted to look like a hospital space, and designed for training teams in the field. On this episode, Dr. Samreen Vora interviews Suzanne Nelson, a simulation education specialist at Children’s Minnesota, who shares her experiences with the Mobile Simulation Center providing health care professionals an opportunity to practice clinical scenarios and reflective debriefing in a mobile clinical setting.
Dr. Angela Kade Goepferd: This is Talking Pediatrics, a clinical podcast by Children’s Minnesota, home to the Kid Experts, where the complex is our every day. Each week, we bring you intriguing stories and relevant pediatric health care information as we partner with you in the care of your patients. Our guests, data, ideas, and practical tips will surprise, challenge, and perhaps change how you care for kids.
Welcome to Talking Pediatrics. I’m your host, Dr. Angela Kade Goepford. We’ve learned a lot about simulation over the last two years through our simulation sessions on Talking Pediatrics. Still, most clinicians assume that simulation is something that takes place at the hospital. Given how beneficial simulation can be to helping us improve patient care, mobile simulation, which brings vehicles equipped with spaces to simulate patient care areas, has steadily increased over the last decade, bringing simulation to you. Since 2007, the Children’s Minnesota mobile simulation center bus has traveled to provide hands-on practice for health care professionals across the region. Our mobile simulation center is a 40-foot RV outfitted to look just like a hospital space and designed for training teams in the field. On this episode, Dr. Samreen Vora interviews Suzanne Nelson, a simulation education specialist and kid expert at Children’s Minnesota who shares her experiences with the mobile simulation center, providing health care professionals an opportunity to practice scenarios and debriefing in a mobile clinic setting.
Dr. Samreen Vora: Welcome to Talking Pediatrics, Sim Sessions with Dr. Samreen Vora. Today, joining me is Suzanne Nelson, our very own simulation education specialist at Children’s Minnesota. Suzanne practiced as an RN for 15 years before obtaining her master’s degree and her Pediatric Clinical Nurse Specialist Board Certification. She’s now spent the last six and a half years of her career as a simulation education specialist at Children’s Minnesota. During that time, she’s also completed a simulation fellowship with the International Pediatric Simulation Society. And simulation education has really been a huge passion of Suzanne’s career. She’s worked, during her time in sim, across simulations in the CVICU with ECMO sims, distress debriefing, and of course mobile simulation outreach. Welcome, Suzanne. I’m so excited to have you with us today.
Suzanne Nelson: I am very excited to be here too and talking about one of my favorite things, which is mobile sim.
Dr. Samreen Vora: Which has been a part of our organization for 15 years. And during those 15 years, many other organizations across the country have followed suit with this type of program. I actually was looking up some things and I found, just recently in 2020, a book was published focused on mobile medical simulation as part of the comprehensive healthcare simulation series. So in short, for those who are listening, to summarize, mobile training programs bring vehicles equipped with spaces to simulate patient care areas, task trainers, and mannequins directly to the healthcare professionals or medical providers in our communities. Can you tell us a little bit about the history of our Children’s Minnesota simulation program, Suzanne?
Suzanne Nelson: This was a little before my time in 2007, I was still working as a bedside nurse, but 2007, we were really lucky to get a grant from Kohl’s, which is the actual Kohl’s department stores. They gave us some money to retrofit and customize a 40-foot RV into an education space that has a nice AV system to allow us to record our simulations. It has a classroom space that we can adapt to different environments, so we can make it look like an emergency department. We can have it be an OB delivery sim or neonatal sims. We can have it really function as any kind of simulation classroom space. We also have a nice little debriefing space where people can review videos. We can look at our simulations and people can use that as a teaching space as well.
Our mobile sim start in 2007 really marked the beginning of our sim program, actually, here at Children’s, which is pretty cool too that we started so long ago. And really, at the time, it was one of the few mobile simulation programs in the country. And even more, we were one of the only pediatric focused ones too. So, we were pretty innovative and really thinking ahead, and our program director, Karen, has been at the forefront of a lot of this work. And she’s worked really hard to get the sim program where it’s at today.
Dr. Samreen Vora: Yeah, [inaudible 00:04:35]. We were almost, as you share that, we were ahead of our time. That’s how we started, and then we focused more internally. And then, now we’ve started to really go back out there with our mobile simulation program. I wonder if you could share a little bit more about the benefits of the mobile simulation program?
Suzanne Nelson: I think one of my favorite things is going out to where the people are. I think about simulation in that immersive element. And one of the ways we can immerse ourselves is going to where the people are. The nice thing is too, is oftentimes we’re going to these small hospitals that don’t really have dedicated sim space, nor can they really accommodate us to have some of their sim space. So, us bringing everything to them and all they have to do is show up is really nice. And it’s nice to be able to provide pediatric sized mannequins. There’s a lot of adult simulation type things out there. There’s not a lot of pediatric stuff. We’re really lucky, at Children’s, that we have such a robust program where we can provide people with that kind of thing.
I think it’s also a really unique way to build partnerships. And I know, Samreen, you have been out on the bus with us a few times. It’s really cool to talk to people and just develop these relationships with folks that, they hear, oh, Children’s, it’s like this big level one trauma center where we get all these really, really sick children. And I think that can be a little intimidating. And now, we can develop these partnerships and relationships, and they can see, oh yeah, we’re just regular people too. And they can feel more comfortable calling us and saying, “Hey, I have this really complicated kid I need to send you.” It breaks some of those barriers.
Dr. Samreen Vora: I joined the team after the bus had been around for a very long time. And I remember Karen, our director, saying we used to go out for pretty much the whole summer. The bus would be at all these different places. And I know you were here for a little bit, right at the end of some of that work. Can you talk about how we would do that? How did that go typically inviting people to parking lots. I’ve heard Karen talk about it, so I wonder if you could talk a little bit about it.
Suzanne Nelson: Yeah. When I first started working, I think I’ve been here now for almost seven years, we had waned a little bit with the bus stuff, because we had our internal simulation program at Children’s was really building. We were having quite a bit of demand, so that, while we loved going out there, the demands of our internal needs exceeded our external needs. But now that we’re developing more partnerships, I think we’re able to get more people involved. A couple of the ways that we’ve done that and how that looks is someone will say, “Hey, I hear you guys have this bus. Can we use it?” In 2017, we only went out about five times. 2018, 4. And then 2019 and 2020, we really didn’t go out at all for obvious reasons. With a pandemic going on, it really wasn’t in our best interest to be taking a simulation bus up to hospitals.
We’ve got seven visits scheduled so far this year. And really, it’s almost a word of mouth thing. So, we’ll go to a small hospital in Superior, which is associated with Essentia Health. Well, the other little Essentia Health hospitals are like, “Hey, how come they got a bus? We went in on that action.” And it’s organic in a way that how it spreads, which is really neat. And then, I get, “Oh, we want to come out, and we want you guys to come out and see all that.” I’ve also brought it to a couple different children’s events, Walk for Amazing. So, people can go in and see what the bus looks like, so families can see some of the trainings that we do. That’s always a really cool experience for families.
And then, we’ve done Scrubs Camp a couple times, which is an immersive camp for teens interested in healthcare careers and try to target kids of lower resource schools. So, kids can get a chance to get their hands on medical equipment, and try out scenarios, and do fun things. It is always so much fun to interact with these high school kids that are excited about healthcare and to try to motivate our next generation of healthcare professionals. Because, as you know, that we’re going to have a shortage of people. We have large numbers of health care workers retiring and leaving the profession, and we want to be able to engage those folks too.
Dr. Samreen Vora: One of the ways you were talking about how we built backup, and we’re going out a ton, hopefully this year we went out a couple times last year. And I think part of that has been this big research project that you have head on. It was started by a couple of our team members that prior, and then you took it by the head, and you’ve moved forward. I wonder if you could tell us a little bit more about that?
Suzanne Nelson: Yeah. In 2019, seems like a long time ago, we got a grant from Children’s Research Fund to conduct some research. It was something that a couple of my previous coworkers we’d always talked about, “We need to do some kind of research stuff on the bus. Because, we have this cool thing, and let’s just prove that it’s actually beneficial for folks, and let’s figure out a good research project that might do some of that.” We ambitiously started this in 2020, and everything ground to a halt unfortunately. And that hared our travel and really made it challenging to re-up some of our sites and those types of things. Thankfully our research group has been extremely generous by allowing us to have extensions and being really flexible with allowing us to still conduct this work, even though it has been like a two-year, almost three-year, battle of trying to get out there. And so, we’re starting again this summer. And we have plans to finish collecting data by August 2022.
Really, what we’re doing is we’re comparing different types of skill sessions. So, thinking about how we teach skills to folks, like is there an optimal way to do that? And we’re looking at a couple of different ways and adding it to our pediatric simulation sessions to see if it has any positive effects on any key aspects of the critically ill trauma patient, such as time to intubation, ordering medications, noting when a patient is in respiratory failure. So, looking at those markers and seeing if the addition of a skill session actually enhances some of those things. Right now, we have some data from three sites, got seven more in the works. Fingers crossed that some of these will confirm up. But now that things are, I guess, settling down for the moment, we’re going to just take our window of opportunity and try to get some sites done as soon as we can.
Dr. Samreen Vora: There’s been experiences where there are new providers, or new nurses, or those that just don’t see a ton of kids. And we’re able to bring some of that out there. Can you give some examples, without talking about differences in the sessions you do, maybe some examples of scenarios that you practice within, with the teams that are out there, and maybe even who’s composed on those teams, interdisciplinary.
Suzanne Nelson: Sure. There’s a couple different things that we do. We typically do some scenarios that are feasible for these low resources places. We’re not going to hit them with complicated trauma, because they simply wouldn’t really get those kids. They would probably bypass some of these places. So, we want to think of trauma instances of in the lens of, what do you need to do in the next 10 to 15 minutes, half an hour, before this patient transfers out? So, we try to cater our scenario. So, we’ll do like a head trauma kid that has a fall or has minor injuries, but starts to decompensate. So, those types of situations where they’re still going to have to put their critical thinking skills to the test, but maybe not in a way that outweighs what their abilities are, what resources they can provide for that patient. So, keeping it within the confines of what they can actually do.
Our target demographic for our low volume EDs are like level three, level four, hospitals. And those level three, level fours, they don’t have a lot of those resources on site, such as certain specialists that provide orthopedics, or certain kinds of surgeons, or the diagnostic tests that they would need for a trauma. So, we just want to make sure we’re keeping it within that frame that would be feasible. So, it’s not like, “Oh, well we wouldn’t get that.” So then, what’s the point of the scenario, if they don’t-
Dr. Samreen Vora: [inaudible 00:12:19] scenario, yeah, exactly. Scenarios that align with the resources they would have. And then, in addition, actually that helps us to get at making sure they have all the resources they can have, helping them also look at their own equipment, and supplies, and resources. Do you want to say a little bit about that?
Suzanne Nelson: Oftentimes, we’re there to do scenarios and provide education. But sometimes I think, “Oh, we’re kid experts now?” And then, I’m like, “Yeah, I guess I am a kid expert. I know I’ve done pediatrics for 20 years now, so I have to just own that I’m an expert.” And just like you, Dr. Vora, you got it. We’ve got to own that we’re experts. And when people come to us, we’ve got to impart some of our knowledge.
It’s another bonus of being out there as we can say, “Hey, you guys don’t have the most updated med book.” As you know, in pediatrics, we do everything weight-based. And if they don’t have an accurate med book, they could potentially giving something that we don’t really use anymore, or that’s not helpful for them. And then, just looking at some of their equipment sometimes we’ll see, oh, you guys have some outdated airway equipment, and this isn’t really something that we really use anymore in pediatrics. They’re like, “Oh, we didn’t know that.” They do have budgets for some stuff like that. So, it’s nice to be able to say, “Hey, yeah, we think this is great, what you have, but let’s just try to up it a little bit better, let’s get you right to where you need to be clinically, so you can feel successful when you’re taking care of pediatric patients.”
Dr. Samreen Vora: I’ll add that, we’ve done, as you’re mentioning, being able to identify some of that equipment we’ve used, the pediatric readiness score. There have been times, I think, that we’ve gone out and done some of those pediatric readiness scores with these community EDs, identifying resources. And we’ve used resources from the National Pediatric Readiness Project and partnered with our community, and also partnered with the MSC, and with our own Children’s Minnesota outreach team as well. Because they’re out there in other capacities as well, sim, and our mobile sim is one piece of that. And so, we’ve made sure to align with the other efforts that we’re all making.
We’ve also participated in the ImPACTS national work, Improving Pediatric Care Through Simulation. That’s what the ImPACTS stands for. That work allowed us to really go out there into our community, but then share our learnings from locally and from this state with the national community that’s building these mobile sims and really trying to get out into those communities that might not have those pediatric resources. And so, we were able to share our learnings of the 15 years, but then also learn from the national community on this mobile sim work. And so, it’s just been really great how open and collaborative our sim community has been, and this focus on really improving the care for kids around the country and around the world. Where do you see our mobile sim program going next?
Suzanne Nelson: Keeping it up to speed with just keeping the day-to-day of getting it out there up to date. But also one thing I think about too is I’d love to update our AV equipment in there. It’s seen better days. I’d like us to move to more digital capabilities of playback and just things to make things a little more streamlined, so we can share things a little bit easier with folks. I would like us to develop more partnerships with some of our partners. There are areas that are one to two hours outside of the Twin Cities bubble. If they’re seeing kids and they’re doing the initial stabilization, we wanted to optimize that stabilization. So, when they’re coming to your emergency department, Samreen, that they’re head of it. Right. And that you’re like, “Oh my gosh, they did all this stuff already. This is amazing.” It just makes our job so much easier and alleviates some of their anxiety too. It’s like, “Well, I know I can do these three things before we send this kid to Children’s.” So, I’d love to see us do more that.
And I could see us doing more things with… I was just thinking about our National Guard stuff, some of the disaster preparedness, and where can we do some work with emergency preparedness? As we know, being in a pandemic, I think we’ve learned that we need to be prepared for anything, and where we can leverage some of that mobile sim work with that would be really cool too.
Dr. Samreen Vora: I’m really excited to continue to work with the mobile simulation center, get the bus out this year, see the results of your mobile sim research. There’s just a lot to come in this area. Well, thank you so much for joining us today, Suzanne.
Suzanne Nelson: Thank you.
Dr. Samreen Vora: And I’m excited to hear about your results in the future.
Suzanne Nelson: Thank you. It’s been fun.
Dr. Angela Kade Goepferd: Thank you for joining us for Talking Pediatrics. Come back each week for a new episode with our caregivers and experts in pediatric health. Our executive producer and showrunner is Ilze Vogel. Episodes are engineered, produced, and edited by Jake Beaver. Amy Juba is our marketing representative. For more information and additional episodes, visit us at childrensmn.org/talkingpediatrics, and to rate and review our show, please go to childrensmn.org/survey.