The value of clinical innovation in enhanced ambulance simulation training

Authors: Prof. Andy Newton and Darren Best

Published in: Autumn 2018 Edition of Ambulance Today Magazine

The value of innovation to patient care cannot be overstated, but its further benefits of efficiency and cost-effectiveness within the NHS make it a vital and ongoing campaign. In this joint article, Professor Andy Newton offers some valuable insights into the value of continued innovation across the NHS before shining some light on clinical simulation in particular. Senior Education Manager at SCAS, Darren Best, then introduces us to the advanced facilities and training going on at their new Education and Enhanced Simulation Centre in Newbury, Berkshire.

Innovation and why patient care needs more of this elixir

Healthcare is no stranger to innovation, and to its credit, the National Health Service has an enviable track record of deploying new methods and technology across a spectrum of patient needs. Examples such as Magnetic Resonance and Computer Tomography, are well known and many others across the spectrum of therapeutics, prosthetics, the application of genetics and more recently robotics continue to capture the imagination of the public and those who work in healthcare alike. South Central Ambulance Service’s new Education and Enhanced Simulation Centre is a forward-thinking example of innovation which applies directly to the field of paramedicine.

The NHS even has an ‘Innovation Accelerator’ programme and a well-promoted list of innovations, including items of direct relevance to those who have an interest in Paramedic and Ambulance matters generally, such as the National Early Warning Score, NEWS. Innovation therefore doesn’t have to be about new products, but can extend to new methods of assessment, new ways of designing, clinical process, where telephone triage could be viewed as a highly relevant example, or in services and new ways of training, about which more in a moment, as well as to many other aspects of care and quality improvement.

But innovation is hard, it is not always welcomed and can often be resisted by those who, for whatever reason, are less attuned to change, not least by those in authority or their confederates who seek the status quo and an easy life free from excitement and risk. It is therefore particularly welcome when innovation works, because it is very likely that the innovation concerned will have been in no small part a function of effective leadership. Leadership that will have come from the hard work, blood, sweat and tears of a few highly energetic individuals who have battled against inertia and the often-lukewarm desire of bureaucratic organisations to modernise. All because the personalities involved have a desire to see services improve for patients and staff alike.

The Innovation of Clinical Simulation

South Central Ambulance Service’s new simulation centre will be judged by the above criteria– the innovation of simulation applies directly to the work of ambulance crews and holds out the promise of raising the quality of patient care. Clinical simulation has a surprisingly long history and demonstrates how several trends have come together to create a series of technologies and teaching methods which, in the right hands, are much more than the sum of their parts. Simulation training represents the vital partnerships that are so necessary between industry and clinicians, with the skills and abilities of both groups demonstrating the very positive results of pooling their talents.

There is no doubt that clinical simulation, when applied to the education of ambulance staff, as with other groups of health care workers, can have a very positive effect on raising competence and greatly helps to prepare for the challenging world of pre-hospital care delivery. This area has also become a much better researched area of practice and while there is insufficient time to do this important aspect justice in this short piece, the evidence base is growing at a rapid rate. It is, however, very important never to over-emphasize the role of the technology over the role of the teaching faculty, the quality of teaching scenarios and the process of debriefing, as well as the reflection of the processes of learning generally. Clinical is therefore one of those innovations that few in the business of clinical education would wish to be without. It is a set of methods that, at its best, integrates sound educational approaches, with a well-designed curriculum and teaching methods, with digital and physical technologies that increase the changes of producing high quality practitioners and that is a goal worthy of the leadership efforts involved.

Andy Newton, 27th August, 2018

The SCAS Education and Enhanced Simulation Centre

In the last three years, South Central Ambulance Service’s Education team has revolutionised the delivery of pre-hospital education and training. The SCAS Education and Enhanced Simulation Centre based in Newbury, Berkshire provides high-technology learning environment facilities that simulate settings ambulance crews would encounter daily. Six purpose- built training and environment rooms allow recreation of the patient’s journey, from their home environment (including a bathroom, kitchen and bedroom) through treatment enroute to hospital in the Mobile Simulated Ambulance (Simbulance) to handing over the patient in the Emergency Department (ED) resuscitation bay. The centre also houses a multi-purpose skills room for delivery of a range of skills from manual handling training for patient transport staff to invasive cannulation and suturing for specialist urgent care paramedic/ practitioners. Collaborative multi-agency working is facilitated in a mock flat which has been used to great effect in joint police and ambulance mental health awareness training.

The pièce de résistance is a fully immersive projection room enabling multi-environment training. This places ambulance staff at a variety of locations such as on a motorway, in a children’s playground or even at a marina!

Education sessions are controlled via a central control room where the simulation technologist can operate all rooms with interactive bespoke software and tablet technology designed specifically for the centre. This allows the creation of safe, realistic scenarios conducive to learning. All training rooms have audio and video capability with playback analysis and feedback available in a dedicated debriefing room on an interactive SMART TV, with the addition of glass whiteboards with street-map view projection for major incident table-top exercise learning.

Simbulance is housed within the centre, and when docked, it can be used as an integrated training area connected to the network and controlled via the central control room. Undocked, Simbulance can be driven to local or cross-border ambulance stations to be used as a standalone simulation facility. This increases the capacity and capability to deliver dedicated training sessions without placing strain on ambulance operational demand.

I am proud to lead the Newbury Education and Simulation training centre alongside a dedicated team of clinical (doctors, paramedics and midwives) and non-clinical educators on the teaching faculty. Together they facilitate a range of sessions from Trust statutory and mandatory education to partnership community maternity and mental health training. The facility has been utilised by all grades of staff including patient transport staff, front-line paramedics and specialist operational teams such as HART. Importantly, the centre also provides a safe space for operational officers to develop and retain clinical and non-technical skills.

The Education and Simulation Centre team has provided pre- hospital training to multi-disciplinary and inter-professional healthcare groups by delivering previously unheard-of immersive capabilities. By promoting and expanding training realism, we have enabled role advancement, staff development and workforce stability, thereby providing safer patient awareness and patient care.

Darren Best, Senior Education Manager, SCAS

To find out more about South Central Ambulance Service, please visit their website: www.scas.nhs.uk

Or send direct enquiries to: simulation@scas.nhs.uk

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