Simulation to train treatment and care


Twenty years ago, Karolinska was working with the continued education and training of healthcare personnel in much the same way as with airplane pilots, by using simulations etc. All according to the motto: “The patient first, but not first on the patient”. However, it all began with a hole in the wall in the culverts at Solna.

The doll has died!

There is a sharp knock on the door, after which a licensed practical nurse reports the dramatic news of a cardiac arrest. Admittedly, on a doll, but that doesn't stop an intensive care nurse at the interview from rushing to the rescue.

Because, whether it involves a cardiac arrest, brain surgery, care of a premature baby, wound care, catheter placement or an appendectomy, practice is a must, for the patient and for those who administer care. The Clinical Skills and Simulation Center (KTC), where both students and hospital personnel are trained in all aspects of baseline and specific care, has been a part of Karolinska University Hospital since 1998.

They are extremey satified with the training being hands-on.

– Everyone needs practice, but the first practice sessions should not be done on the patient. Our motto is: The patient first, but not first on the patient.

So, states Gunilla Bolinder, chief physician and Director of the Clinical Skills and Simulation Centers (KTC) in Huddinge and Solna. The operations are dear to her heart.

– In the past, you watched while a senior doctor operated on an appendix. And oftentimes you had to do it by yourself, way too soon. After that, you were considered sufficiently capable enough to start training other, explains Gunilla Bolinder.

The idea of patient safety began to be taken seriously in 1999 when the American book "To Err Is Human" was published. It presented statistics from the USA showing that over 250,000 patients die, each year, as a result of avoidable medical errors.

– It was a scary reality. When compared to flying, no such carelessness existed due to the simple fact that pilots really want to return to earth alive, explains Gunilla Bolinder.

In conjunction with the publishing of the book, the opportunity to train communicative and technical competence in a calm situation, a safe environment was born. If a person makes a mistake during a simulated training session, the error can be corrected, the mistake can be analyzed, and thus, avoided in the future.

In the same spirit, a deviation system was created around 2002, whereby any mistakes that were made in care were to be reported as a deviation. A further piece added to the patient care safety puzzle.

Our motto is: The patent first, but not first on the patient.

Since its start in 2008, KTC operations have successively grown and in 2018, it moved into newly built facilities in the BioClinicum, in the new hospital building in Solna.

– Today, we have an optimal location in Solna, with a fully equipped ward and ultramodern equipment. Here, you can conduct live training on the exact technical equipment you will be using in your role in healthcare, says instructor and intensive care nurse Björn Lindgren.

In other words, all of the equipment at KTC reflects the actual equipment in the hospital.

– In the past, we usually trained in our own clothes and practiced injections on oranges and old rag dolls. Today, you wear hospital gear according to the hospital's uniform and hygiene regulations and practice on realistic dolls. This causes you to take the practice sessions more seriously, says Gunilla Bolinder.

The dolls lying in the beds on the ward are as realistic as possible and are capable of coughing and talking, have heartbeats and the capacity to allow the placement of ports and catheters, etcetera.

The doll that was in cardiac arrest has been revived, which is important for the group in training. On this day, there are nursing students from the Swedish Red Cross University College:

– Participants can make mistakes when we simulate real-life situations. Such an event can have lasting effects on the students, so that is why the instructor steps in and saves the doll's life, which is important to the group, says Björn Lindgren.

Training is about communicating with "the patient" and meeting them in the correct way, sort of like working ergonomically correct.

– We have training from baseline training for novices to extremely complicated things for those already extremely proficient, such as robotic surgery, angiography, coloscopy and other such procedures, says Gunilla Bolinder.

KTC's operations stand on four legs. In addition to continued education of its own healthcare personnel in simulated and scenario situations, they also accept students from KI and the Red Cross' nursing programs and arrange concept training at the national level that targets special groups throughout the country, such as trauma and anesthesiology.

When a practice session has gone awry, a common reason is often a breakdown in collaboration and communication. This can be remedied with a variety of methods that are in actual use in the hospital. One of them is as simple as introducing yourself and your roll right before the operation starts, especially since the training situations are interprofessional.

Gunilla Bolinder and Björn Lindgren

– All personnel really know their fields, so that the right attitude, knowledge and awareness of the risks can contribute to patient safety, says Björn Lindberg.

And although a lot has happened over the past 20 years, he believes that the future holds even greater opportunities:

– I think that we will see a lot of training and simulations using online software and computer-aided training in preparation for coming here. Moreover, knowledge tests to maintain competency levels might be introduced, he says and adds:

– The students, from both the doctor and nursing programs, usually say this is the best thing they have done in their entire education; they are extremely satisfied with the training being concrete and "hands-on".

Clinical skills and simulation center KTC

KTC is part of Karolinska University Hospitals Research and Education structure (FoU).

KTC opened in 1998, with locations in Solna (the new hospital building, BioClinicum) and Huddinge (ground floor of the dental medicine facilities).

Text and Photo: Carin Tellström