August 23, 2022

In collaboration with the Simulation Center, the Pavilion for Women team leverages simulation to improve outcomes. Read more

April 22, 2020

Lauren Salinas, a clinical specialist in the cardiac intensive care unit, shares how her experience participating in an intubation simulation is helping her and other nurses prepare for what to expect when caring for potential COVID-19 patients during high-risk procedures. Read more

May 8, 2018

On Tuesday, May 22, Legacy Tower at Texas Children’s Hospital officially will open its doors to care for our most critically ill patients and their families. But before that day arrives, a lot of preparation and training is underway to get ready for opening day which is less than two weeks away.

Last month, multidisciplinary teams successfully completed a series of simulated patient care scenarios inside the Legacy Tower’s state-of-the-art pediatric intensive care unit (PICU), Progressive Care Unit (PCU) and OR/MRI suite to test the workflow processes in the new patient care spaces and address any potential safety concerns before the new building opens.

“For the PICU, we really focused on creating a virtual unit,” said Dr. Cara Doughty, medical director at Texas Children’s Simulation Center. “We wanted the team to participate in all of the routine work flows as well as participate in crisis scenarios and patient decompensations and codes that might happen in a PICU setting.”

In addition to clinical staff, patient families from Texas Children’s Family Advisory Committee participated in the PICU simulations and provided their perspective on how much this space is going to change the way that care is provided to children and families at Legacy Tower.

A few weeks after the PICU and PCU simulations, patient care scenarios were conducted in the operating room and MRI suite of Legacy Tower to address any potential latent safety threats and concerns before the new tower opens its doors to patients and their families.

“Our focus is not as much on design now, it’s really around those processes,” said Maria Happe, clinical senior project manager of Texas Children’s PICU Services. “We want to ensure our processes are correct, and that we ensure our training matches what we want to do and how we want to operate in this new space.”

Once the first phase of Legacy Tower opens on May 22, the tower will house new operating rooms with one intraoperative MRI, as well as a new PICU which will span four floors and open with six ORs and 84 ICU beds, including dedicated surgical, neuro and transitional ICU beds.

When phase two of the Legacy Tower opens in fall 2018, the tower will be the new home of Texas Children’s Heart Center® – ranked No. 1 in the nation by U.S. News & World Report in cardiology and heart surgery. The Heart Center will have an outpatient clinic, four catheterization labs with one intraprocedural MRI, cardiovascular intensive care unit, four cardiovascular ORs and cardiology acute care beds. The tower also will have a helistop, allowing for even greater access to Texas Children’s most critically ill patients.

The Legacy Tower project would not have been possible without tremendous collaboration from teams and departments across the organization. Click here to view the Legacy Tower Activation Teams and Departments that played an integral role in the design, construction and activation of Legacy Tower.

Employees and staff can see more of Legacy Tower on Connect throughout the month. Texas Children’s Corporate Communications Team will feature a series of stories and videos on Connect promoting Legacy Tower and sharing how we are preparing for this historic move.

November 22, 2016

Simulations test readiness of new Outpatient Facility in The Woodlands

Ready, set, go!

“Are you OK?” a nurse asks a patient who stumbled to the ground after an unsteady walk to an exam room at the new Texas Children’s Hospital The Woodlands Outpatient Facility. “Help!”

A slew of medical staff come rushing to the girl’s aid, some comforting the patient’s mother and others tending to the girl’s lethargic condition. During what looked like controlled chaos, medical staff rolled equipment into the exam room, ran up and down hallways to gather more help and within what was just a few minutes stabilized the patient.

This was one of 11 scenarios played out during a three-day simulation at the Outpatient Facility before its doors opened for business on October 4. The purpose of the simulation was for medical staff to test their new environment, not their clinical abilities. Were there enough supplies? Is medical equipment in the right place? Is the room set up properly?

“Architects are great at creating these beautiful environments but are they friendly to the providers who are actually seeing patients,” said Julie Barrett, director of outpatient and clinical services in The Woodlands. “Testing those environments to see if we’re able to provide high quality patient care is what we hope to learn from simulation.”

Jeanette McMullin, a nurse in the surgery clinic at the Outpatient Facility, participated in the exercise and said it gave her a good feel for her new clinical space.

“It really took me through the process of what we would do for a patient given the situation and the supplies on hand,” McMullin said. “For me, the outcome was clear and that is we are able to function very well in this new environment.”

Barrett said a robust simulation is planned prior to the hospital opening in April. These efforts will be tailored to inpatient providers and will be led by many of the same simulation team leaders, all of whom are based in The Woodlands and have been trained at the Texas Children’s Simulation Center at Main Campus.

“The staff, providers and leaders have done a wonderful job,” she said. “I am amazed at how vitally important this simulation has been. It’s been a great learning opportunity.”

For more information about the Outpatient Facility, click here.

February 23, 2016

22416simulationinside640The neonatal team at Texas Children’s Pavilion for Women is always prepared for special deliveries – taking care of newborns is what they’re trained to do. But earlier this month, the neonatal intensive care unit (NICU) received a special delivery that wasn’t quite what you’d expect.

Texas Children’s Simulation Center hosted an open house to introduce Tory, a high-fidelity infant mannequin, and the newest addition to the first-ever Neonatal Comprehensive In Situ Simulation Program launched at the Pavilion for Women’s Newborn Center. The simulation equipment and supplies were purchased with a generous $200,000 grant from the M.D. Anderson Foundation, which will also support an in situ simulation program for the Emergency Center and Critical Care, as well as one for the NICU in West Tower once a dedicated space for simulation has been identified.

“We’re grateful to our Newborn Center leadership for dedicating a simulation room at the Pavilion,” said Dr. Jennifer Arnold, medical director of the Simulation Center. “Now, our NICU providers can train in their actual practice environments during regular workdays to enhance individual and team performance – particularly in high-risk situations – and improve patient outcomes and safety.”

The in situ simulation program focuses on improving crisis resource management skills, one of which is role clarity. During a code, the potential for confusion and chaos can easily set in as responders attempt to care for a patient in a high-risk medical emergency. Clinicians responding to a code may not always be sure of their roles or the roles of their team members when they arrive, and that’s when in situ simulation training becomes crucial to patient safety and care.

“First, we conducted tests to determine the necessary roles in a crisis, whether it’s a resuscitation or a code,” said Dr. Mona Khattab, one of the in situ simulation program directors for the NICU. “By having the necessary personnel at the code, we alleviate staff overcrowding and ensure optimal efficiency and clear communication are achieved while delivering lifesaving treatment to our NICU patients.”

Inside the simulation room, colored labels – red, yellow and green – are affixed to the floor that encircle the bedside. These labels identify the specific roles of each of the code response participants and directs them to their position on the floor during a medical emergency.

  • The red team consisting of clinicians and nurses stand in the innermost circle closest to the bedside where they provide direct patient care.
  • The yellow team is positioned behind the red team. They support patient care providers by documenting the code, handing over equipment, managing the ventilator and medication and blood prep drawers, and providing mentorship and consultations to the team leader as needed.
  • The green team stands in the back of the room near the code cart and provides overall code and room support to ensure everything is running seamlessly.

“When a text message page is sent, the unit reports to the simulation room as if it were an actual page in the unit to respond to a code,” said Kellie Kainer, assistant director of Nursing for the NICU at the Pavilion for Women. “We give them a brief history of the patient and alert them to the code.”

The in situ simulations will occur every Thursday and last 10 minutes followed by 20 minutes of debriefing. The NICU teams alternate every week and are selected based on their current assignment and the flow of the unit on that particular day.

“We’re focusing on one specific patient case so that everyone gets exposure to that case,” said Dr. Leigh Ann Cates, a neonatal nurse practitioner and a program director for the in situ simulation program. “As our program expands, we hope it will become a model for in situ simulations in other units of the hospital.”

In preparation for this training, all clinicians within the Newborn Center complete an online pre-simulation course through Healthstream. The Simulation Center developed a series of powerpoint presentations covering crisis resource management skills, an orientation to simulation, and what to expect during simulation such as a confidential and psychologically safe learning environment.

February 17, 2015

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Around 100 BC acupuncture simulation was used and recorded in China. The long history of simulation has helped health care workers learn difficult procedures and manage high risk or complex patient care situations before they’re done on actual patients. It’s a sort of “practice” for real life situations in the clinical world. In 1910 life-like simulators were created. While Texas Children’s has been practicing simulations for many years, five years ago, under the leadership of Dr. Jennifer Arnold, neonatologist and medical director of Texas Children’s Simulation Center, the simulation center was created. It is a dedicated space in the Feigin Center which gives caregivers a safe space to practice life-like situations with simulators which react just as humans would.

In November, simulation experts from the Center for Medical Simulation (CMS) at Massachusetts General Hospital and Harvard Medical School held a four-day course, the Institute for Medical Simulation (IMS) course, for health care providers interested in or already leading simulation efforts across Texas Children’s. The course is one of the most comprehensive and immersive simulation training programs available and focuses on how to implement best practice simulation for improving quality, patient safety, and education. Four days of theory, practice, and reflective feedback create a truly experiential education where our simulationists develop a strong and comprehensive understanding of how to most effectively use simulation within their departments and educational programs.

“The goal of bringing the IMS course to Texas Children’s is to transform our simulationists to be outstanding simulation educators,” Arnold said.

“This course is a chance to have top experts in the field teach us about debriefing after a simulation exercise,” said Cara Doughty, Emergency Center physician.

Debriefing during or after simulation is singularly the most critical aspect to a successful simulation activity. It is where the learning occurs. Debriefing involves a discussion led by a trained expert reviewing what went right, how each person performed, what should have been done differently and how this situation could be improved in the case of a real-life scenario. It also is the most challenging aspect of implementing simulation, typically debriefing techniques are not instinctive to most healthcare providers and require rigorous practice.

Simulations can take place both at the Simulation Center and in real patient care settings like the operating rooms. Bonnie Eaton, a nurse in the operating rooms, has seen a great benefit with being involved in these courses as well as encouraging more simulations for operating room staff.

“It’s reassuring to the staff to have the ability to practice these scenarios before they are experiencing them with real patients,” said Eaton. “In the ORs, we are trying to develop a program to get all of the staff involved in simulations.”

Arnold has been a major advocate of bringing more simulation training activities to all areas of the hospital. Currently, simulations are done with clinicians from almost every area of the hospital and simulation scenarios have helped the staff prepare for major surgeries like the Mata conjoined twins separation surgery, and even for the possibility of a patient with Ebola visiting the hospital. Simulations play a key role in preparing the staff for these rare cases and helping determine the best course of action.

The simulation experts from CMS come from diverse backgrounds, but all have simulation educational expertise in common. Dan Raemer, PhD, has a background in bioengineering and is an expert in teamwork and crisis resource management. Walter Eppich, MD, Med, is a pediatric emergency medicine physician and is an expert in debriefing and faculty development. Kate Morse, PhD, MSN, RN, is a critical care advanced practice nurse and an expert in interprofessional education.

“Having Drs. Raemer, Eppich, and Morse here really re-energized the overall simulation program at Texas Children’s Hospital,” said Kelly Wallin, assistant director of Texas Children’s Simulation Center. “It is vital that we continue to develop and support a strong expert team of simulationists across the institution so we can implement simulation activities in all patient care areas.”

Not only did the visiting faculty lead a 4 day course for 20 simulationists here at Texas Children’s Hospital, but Dr. Raemer gave two innovative grand round presentations, one to pediatric surgery and the other to pediatrics. Simulation is becoming a more recognized and even standardized quality and safety tool across the nation and even internationally.

“We need to support and develop simulation activities not only to be a leader in quality, safety and education, but also to better serve our patients,” Arnold said. “The simulation center resides within the Quality and Safety Department at Texas Children’s Hospital because we recognize the value of it to patient care outcomes and safety.”