Education Management Solutions (EMS) congratulates Virginia’s Centra Health and Lynchburg College (LC) on the recent dedication of  the Central Virginia Center for Simulation and Virtual Learning, which will be managed jointly by the two institutions.“Simulation is the latest and most effective type of education in which students can intervene, make decisions, and take actions in a highly controlled environment,” says Patti McCue, Sc.D., R.N., MSN, NEA-BC, Centra senior vice president of patient care services and chief nursing officer. “The process allows the creation of clinical situations that could not be created in a hospital setting. It also is an excellent way to teach and promote patient safety. Students can practice in a controlled environment before working with actual patients.

In addition to students, current health professionals have the opportunity to use the center for advanced technical skill development and to improve communication and collaboration skills as part of a team.”Phase 1, which occupies about half of the more than 15,000 square-foot center has been completed and consists of five acute care inpatient rooms, one critical care inpatient room, one labor and delivery birthing suite, two primary care exam rooms, one home health apartment, and an ambulance venue.

EMS’ Orion solution, the most technologically advanced simulation management and audio-video system for capturing simulation activities, debriefing, and skills evaluation is integrated into the simulation areas of the first phase.  Johanna Derrenbacker, director, Central Virginia Center for Simulation and Virtual Learning, states, “We are really excited to start working with our system. We wanted to make sure we had a state-of-the-art, most up to date system. EMS’ Orion really fits that description.”Derrenbacker continues, “I am amazed by the flexibility Orion has to offer faculty and learners. They can really use the system as little or as much as needed based on their need. If there is a need, Orion can fulfill it.”

Computerized simulation manikins will also be used as part of the overall training. The manikins simulate human actions such as breathing, heart and lung sounds, speaking, crying and other specialized functions.

The Healthcare/Medical Simulation Market has experienced extensive growth over the past few years, mainly attributed to various advancements in technologies. The increasing focus on training of medical practitioners, rising healthcare costs, growing focus on patient safety, and availability of funds has helped increase the purchasing power of academic institutes, thereby driving the growth of the market.

The Medical Simulation Market mainly consists of simulation products and services that are used to train students and healthcare practitioners. The high fidelity mannequin/patient simulators market is lucrative for companies to invest in, as it is a major contributor to the market and is forecast to grow at a healthy CAGR from 2012 to 2017. Academics, hospitals, and military are the major end-users of medical simulation products. Academics accounted for the largest market share in 2012 primarily due to increased focus on training of medical students and availability of government funds.

North America is the Major Market for Medical Simulation, followed by Europe. This is attributed mainly to the presence of major players in these regions and availability of funds. Growth in the Asian Market, especially China and India, is likely to be propelled by the increasing awareness of advanced technologies and focus of major players.

Among the prominent players mentioned in the healthcare/medical simulation market study by MarketWatch is Education Management Solutions (EMS).

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(Image at right) A high-fidelity manikin-based simulation event as seen from the control room at Samuel Merritt University’s (SMU) Health Sciences Simulation Center. Education Management Solutions’ (EMS) leading simulation center management software and audio video technology helps to run SMU’s simulation training program.

At North Shore University Hospital on Long Island, motion sensors, like those used for burglar alarms, go off every time someone enters an intensive care room. The sensor triggers a video camera, which transmits its images halfway around the world to India, where workers are checking to see if doctors and nurses are performing a critical procedure: washing their hands.

This Big Brother-ish approach is one of a panoply of efforts to promote a basic tenet of infection prevention, hand-washing, or as it is more clinically known in the hospital industry, hand-hygiene. With drug-resistant superbugs on the rise, according to a recent report by the federal Centers for Disease Control and Prevention, and with hospital-acquired infections costing $30 billion and leading to nearly 100,000 patient deaths a year, hospitals are willing to try almost anything to reduce the risk of transmission.

Studies have shown that without encouragement, hospital workers wash their hands as little as 30 percent of the time that they interact with patients. So in addition to the video snooping, hospitals across the country are training hand-washing coaches, handing out rewards like free pizza and coffee coupons, and admonishing with “red cards.” They are using radio-frequency ID chips that note when a doctor has passed by a sink, and undercover monitors, who blend in with the other white coats, to watch whether their colleagues are washing their hands for the requisite 15 seconds, as long as it takes to sing the “Happy Birthday” song.

All this effort is to coax workers into using more soap and water, or alcohol-based sanitizers like Purell.

“This is not a quick fix; this is a war,” said Dr. Bruce Farber, chief of infectious disease at North Shore.

But the incentive to do something is strong: under new federal rules, hospitals will lose Medicare money when patients get preventable infections.

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A study released today by George Washington University School of Public Health and Health Services (SPHHS) researchers offers an in-depth look at hospitals nationwide and admissions to intensive care units (ICU). The study, published in the journal Academic Emergency Medicine, finds a sharp increase—nearly 50 percent—in ICU admissions coming from U.S. emergency departments.

"These findings suggest that emergency physicians are sending more patients on to the ICU," said SPHHS researcher and lead author Peter Mullins. "The increase might be the result of an older, sicker population that needs more care." The larger question, one that this study couldn't answer, is whether there will be enough ICU capacity in the future to accommodate the growing number of patients, particularly the oldest of the old, the authors said.

Mullins and his colleagues conducted the study by using data from the National Hospital Ambulatory Care Survey, a sample of U.S. hospital-based emergency departments during a seven-year period. They found that ICU admissions jumped from 2.79 million in 2002-2003 to 4.14 million in 2008-2009. The study also shows that during the same time frame overall emergency department admissions grew by only 5.8 percent.

Other key findings of the study:
- ICU admissions grew the most among patients aged 85 and older—increasing 25 percent every two years.
- Utilization of tests and services provided to emergency department patients on their way to the ICU also jumped during the study period, with the largest rise occurring in computerized tomography (CT) or magnetic resonance imaging (MRI) tests. In fact, CT and MRI tests provided while still in the emergency department increased from 16.8 percent to 37.4 percent.
- The most common reasons for ICU admissions were symptoms such as chest pain or shortness of breath that can signal life-threatening conditions like heart attacks.
- On average, patients had to wait five hours in the emergency department before getting into the ICU.

Additional research must be done to find ways to keep critically ill patients from facing long waits in crowded emergency departments, said co-author Jesse Pines, MD, MBA, MSCE, a practicing emergency physician and an associate professor of emergency medicine and health policy at SPHHS.

"Studies have shown that the longer ICU patients stay in the emergency department, the more likely they are to die in the hospital," Pines said. "Better coordination between the emergency department and ICU staff might help speed transfers and prevent complications caused by long emergency department waits," he said.

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Presented by Richard Pizzi, AIA, VP, and healthcare design principal for Lavallee Brensinger Architects.

We had a great response to today's webinar. Feel free to post your questions/comments for Richard in the comments box below.

Abstract: This interactive webinar will explore the planning, programming, and design of clinical simulation centers. We will discuss a collaborative and inclusive process to define your goals and create a space program that accommodates all simulation activities. The webinar will discuss the design of flexible, multi-functional simulation labs and the spatial relationships between labs and support space. The webinar will also review the integration of simulation, AV, and medical equipment as well as lessons learned and current/future trends from active simulation centers.

Richard Pizzi, AIA, VP, is a healthcare design principal for Lavallee Brensinger Architects regional healthcare design firm. Rich has specialized in healthcare design for nearly 19 years. For the past 6 years, he has focused on the research, programming, and design of clinical simulation centers. During this time, Rich has programmed and designed clinical simulation centers for large academic medical centers, community hospitals, medical schools, and nursing schools. His efforts have also included first-hand training observations, site visits, and post-occupancy reviews. Rich is a member of the Society for Simulation in Healthcare.

Medical interns spend just 12 percent of their time examining and talking with patients, and more than 40 percent of their time behind a computer, according to a new Johns Hopkins study that closely followed first-year residents at Baltimore's two large academic medical centers. Indeed, the study found, interns spent nearly as much time walking (7 percent) as they did caring for patients at the bedside.

Compared with similar time-tracking studies done before 2003, when hospitals were first required to limit the number of consecutive working hours for trainees, the researchers found that interns since then spend significantly less time in direct contact with patients. Changes to the 2003 rules limited interns to no more than 30 consecutive hours on duty, and further restrictions in 2011 allow them to work only 16 hours in a row.

"One of the most important learning opportunities in residency is direct interaction with patients," says Lauren Block, M.D., M.P.H., a clinical fellow in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine and leader of the study published online in the Journal of General Internal Medicine. "Spending an average of eight minutes a day with each patient just doesn't seem like enough time to me."

"Most of us went into medicine because we love spending time with the patients. Our systems have squeezed this out of medical training," says Leonard Feldman, M.D., the study's senior author and a hospitalist at The Johns Hopkins Hospital (JHH).

For the study, trained observers followed 29 internal medicine interns—doctors in their first year out of medical school—at JHH and the University of Maryland Medical Center for three weeks during January 2012, for a total of 873 hours. The observers used an iPod Touch app to mark down what the interns were doing at every minute of their shifts. If they were multi-tasking, the observers were told to count the activity most closely related to direct patient care.

The researchers found that interns spent 12 percent of their time talking with and examining patients; 64 percent on indirect patient care, such as placing orders, researching patient history and filling out electronic paperwork; 15 percent on educational activities, such as medical rounds; and 9 percent on miscellaneous activities. The researchers acknowledge that it's unclear what proportion of time spent at the bedside is ideal, or whether the interns they studied in the first year of a three-year internal medicine training program make up the time lost with patients later in residency. But 12 percent, Feldman says, "seems shockingly low at face value. Interns spend almost four more times as long reviewing charts than directly engaging patients."

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Doctors and academics have developed a simulator designed to help anaesthetists deliver epidurals, a medical procedure involving the injection of anaesthetic between spinal vertebrae.

The simulator has been developed by PhD student Neil Vaughan and Professor Venky Dubey from Bournemouth University’s School of Design, Engineering and Computing, alongside Dr Michael Wee and Dr Richard Isaacs from Poole Hospital.

Software and haptics replicate the conditions of giving an epidural to a real-life patient, allowing adjustments for different heights, BMIs, angles, and rotations of the spine.

The system does this by incorporating a Novint Falcon haptic device connected to a 3D modelled graphical simulation. Novel aspects of the simulator are said to include 3D graphics, 26 modelled vertebrae (cervical and lumbar), and patient variation based on measured data. An immersive 3D monitor with polarized images then allows visualisation from different angles using zoom and rotate.

In use the simulator will be used to help doctors train to do the procedure to improve results and reduce the risk of harm to patients.

Dr Wee, a consultant anaesthetist at Poole Hospitals NHS Foundation Trust, said: ‘I developed the simulator because there is a need to provide precise training in a delicate clinical procedure which has potential devastating effects to the mother when things go wrong. 

‘A high fidelity epidural simulator will help to reduce the learning curve and thereby improve the success of epidurals whilst reducing potential harm to the mothers.’

Development of the simulator began in 2010, and it is currently undergoing clinical trials on patients.

The project - which aimed to develop a simulator combining a 3D interactive model of the lumbar spine with a haptic needle injection device - has already received international attention.

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In reviewing 25 years of U.S. malpractice claim payouts, Johns Hopkins researchers found that diagnostic errors—not surgical mistakes or medication overdoses—accounted for the largest fraction of claims, the most severe patient harm, and the highest total of penalty payouts. Diagnosis-related payments amounted to $38.8 billion between 1986 and 2010, they found.

"This is more evidence that diagnostic errors could easily be the biggest patient safety and medical malpractice problem in the United States," says David E. Newman-Toker, M.D., Ph.D., an associate professor of neurology at the Johns Hopkins University School of Medicine and leader of the study published online in BMJ Quality and Safety. "There's a lot more harm associated with diagnostic errors than we imagined."

While the new study looked only at a subset of claims—those that rose to the level of a malpractice payout—researchers estimate the number of patients suffering misdiagnosis-related, potentially preventable, significant permanent injury or death annually in the United States ranges from 80,000 to 160,000.

Diagnostic error can be defined as a diagnosis that is missed, wrong or delayed, as detected by some subsequent definitive test or finding. The ensuing harm results from the delay or failure to treat a condition present when the working diagnosis was wrong or unknown, or from treatment provided for a condition not actually present. "Overall, diagnostic errors have been underappreciated and under-recognized because they're difficult to measure and keep track of owing to the frequent gap between the time the error occurs and when it's detected," Newman-Toker says. "These are frequent problems that have played second fiddle to medical and surgical errors, which are evident more immediately."

He says experts have often downplayed the scope of diagnostic errors not because they were unaware of the problem, but "because they were afraid to open up a can of worms they couldn't close." He adds: "Progress has been made confronting other types of patient harm, but there's probably not going to be a magic-bullet solution for diagnostic errors because they are more complex and diverse than other patient safety issues. We're going to need a lot more people focusing their efforts on this issue if we're going to successfully tackle it."

For their review, Newman-Toker and his colleagues analyzed medical malpractice payments data from the National Practitioner Data Bank, an electronic repository of all payments made on behalf of practitioners in the United States for malpractice settlements or judgments since 1986.

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The rate of laparoscopic hysterectomy has greatly increased over the past decade and is now higher than that of abdominal hysterectomy, according to a study in the April issue of the American Journal of Obstetrics & Gynecology.

Lindsay C. Turner, M.D., and colleagues from the University of Pittsburgh assessed trends among 13,973 patients who had undergone hysterectomies at Magee-Womens Hospital from 2000 to 2010. The researchers found that over this period, laparoscopic hysterectomy increased from 3.3 to 43.5 percent, abdominal hysterectomy decreased from 74.5 to 36.3 percent, and vaginal hysterectomy decreased from 22.2 to 17.2 percent. In 2010, three percent of laparoscopic cases converted to open surgery. Hysterectomy was performed for gynecological malignancy in 24.4 percent of cases. The average length of stay was only 1.0 day for laparoscopic hysterectomy and only 1.6 days for vaginal hysterectomy compared with 3.1 days for abdominal hysterectomy. The average patient age for the three procedures ranged from an average of 46.9 to 51.7 years old, with a significant increase in patient age over time.

"This study confirms that rates of laparoscopic procedures for hysterectomy have dramatically increased over the last decade at our tertiary hospital, which is consistent with other reports in the literature," the authors write.

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