2/ Many of us have experienced it firsthand
during #COVID19 as we piloted & refined new protected intubations/code blue…but how can we make this type of sim happen?
Lots of places now using sim regularly to identify problems & improve processes...here's a bit of a guide
3/ But first, what exactly is translational simulation? Here’s the defn from @socraticEM who first described this term.
4/ What’s key is that it emphasizes function of the sim…what’s it INTENDED to do…not where it occurs or how its done. E.g. in situ sim can be used as a regular training session but it becomes translational when it focuses on improving healthcare systems (or direct patient care)
5/ Briefly, translational sim has 3 broad use cases
1. Better understanding of differences between “work-as-imagined” and “work-as done” along w/ impact of team/institutional culture
2. Integration within QI initiatives to improve performance/outcomes
6/ And my favorite...
3. “Crash test” new spaces, equipment or processes
So if any of these 3 use cases are something you’re undertaking then strongly consider integrating translational simulation into your process…but how?
Well, we got you.
7/ We’ve applied the Input-Process-Output framework to help operationalize this. Illustrated below that I’ll describe in more detail.
Critical is that this is a non-linear (and iterative) process. You might move back/forth between input & process while figuring out the project
8/ INPUT: There’s nothing worse than “solving” something that isn’t actually a problem (or one that doesn't actually exist!)
9/ Conversely defining & clarifying the problem is a critical step and can occur thru multiple ways…
- design thinking,
- participatory ergonomics,
- direct observation,
- observations during simulation…etc
10/ However the problem is defined… it has to involve people on the frontlines, patients and those in leadership roles. A participatory design process is ideal involving clinical/non-clinical team members, patients, leadership.
11/ Make sure during this process, you ask yourself if simulation is right for the job. It’s a tool and like anything when used appropriately, its very powerful, but when used incorrectly, it may not get the job done.
12/ Also, consider whether you’re going to use simulation to “diagnose” the problem or as the “intervention” to solve the problem? Or, it might be both, which is how we used it at our institution 1) figure out problems w/ our MHP 2) to test solutions
13/ There’s a list of further considerations that can/should be applied during the input phase, too much for twitter but summarized here
13/ PROCESS – once you’ve designed on the approach, its time to make it happen. This involves designing and delivering the session(s), collecting data and analyzing it.
14/ There’s an entire literature space emerging on systems-based or translational thinking which I recommend esp if you’re planning a session (including debriefing tools and creating psychologically safety)
Links: stel.bmj.com/content/6/3/132 & pubmed.ncbi.nlm.nih.gov/31135684/
15/ The data collection often includes qualitative and quantitative elements…with a growing number of options
16/ And these simulations should (when possible) link to existing ACTUAL datasets! Think big here! To quote @SocraticEM "its a strategy, not an event".
All those AI people, we're talking to you! Imagine regular simulations integrated and analyzable in institutional databases.
17/ Without the data, however whatever that looks like, its hard to demonstrate the need for change or to show proof that interventions actually work. But don’t let this be a barrier to making it happen either. The data doesn’t need to be worthy of publication...
19/ OUTPUT: Once you’ve run the simulations, collected & analyzed your data, its time to share it! This might be within your institution or more outward facing initiatives (e.g. publications).
20/ Practically, pictures or video clips from simulations are highly useful and (I think) under utilized. We regularly include them in our reports and its far more impactful than any words on the page.
21/ In my opinion, the future of translational simulation lies in how we articulate the return on investment. Maybe its as straightforward as saving the institution money? But let’s think outside the box?
22/ If it takes 100 people hours to make a typical high stakes decision in a hospital, maybe translational simulation can help you do that in only 20 people hours (e.g. 2hr simulation with 10 people…clearly highlighting the likely issue or answer).
24/ This is when it gets really interesting, when we think about translational simulation as an advanced decision making tool. How can it be used to make better decisions, more frequently and with greater certainty. That’s when the impact gains traction.
25/ If you can reliably, accurately and repeatedly predict patient harms before they happen? Well that’s pretty epic.
And if translational simulation can be fully integrated into hospital/healthcare systems...well, that's the future!
26/ There you have it. Some reflections on this paper and how translational simulation can be operationalized…moving beyond theory and into practice.
My take relates to crisis management & influencing behavior 1/
I’m not qualified to comment on whether school closure should continue or not. (personally, as a parent of a 4yr old...please re-open! but not the point here)
Some considerations
2/
1. Transparency: when reports are leaked, there’s high prob for misunderstanding. Transparency in the long run is often the preferred approach (except maybe national security) but it is very true that lack of transparency fosters further mistrust. bit.ly/397ihX8
3/
THREAD: Amazing article how McLaren improved their F1 pitstop times by undertaking a deeper understanding of their teams. & how this relates to healthcare.
They used eye tracking tech to identify the pit crew wasnt focused on the car entering the pit 1/ wired.com/story/book-exc…
Once issues were identified they implemented several design and training strategies:
1. specific actions for each team member 2. train to focus on wheels 3. painted wheel nuts orange
Net result = record setting speed for pit stops and more wins. Impressive work
2/
This is the detailed approach that we must take in healthcare to get those 1% gains (and in fact, probably opportunity for 5-10%) gains.
We use simulation to help understand issues and subsequently design solutions that work....
3/
2/ Why does it matter? Somewhat self evident, but we want to design & test a process that optimizes the number of people who be vaccinated while also ensuring a pleasant & safe experience
Great clip from "the Founder"... example of design #simulation
3/ We began with core objectives/principles for the project.
This informed the blueprints for the design of the space
But we all know, things may look good on paper, but don't necessarily translate to real-life
More importantly, people's behavior can be difficult to predict
THREAD: 5yrs ago we began the TRUST study. Excited to see it finally published in @BMJ_Qual_Saf . This kicked off my interest in using simulation to support patient safety and simulation-informed clinical design.
My mentor, @HumanFact0rz taught me the importance of pitching an idea to the right people. When we started simulation for systems eval & patient safety was uncommon
This SR/MA provides a more fulsome look at the data including this brand new evidence.
2/
The results?
In pooled analysis, TXA likely has no effect on mortality or disability.
A few considerations when I try to contextualize the clinicaly relevance. Not all TBI are equal. GCS 3 =/= GCS 12. A SDH is not the same as SAH or EDH etc. So their are limitations here
3/
For example, my kids go to school, so they are exposed to ~20-30 people/day. An all or nothing approach says it doesn’t matter how I socialize because I can’t achieve perfection (isolate the way public health advises) since my kids are in school.
3/