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Using simulation for workforce upskilling and systems testing

Tess Vawser from the Epworth talks through the challenge of implementing a COVID-19 rapid education plan and hospital readiness systems testing across multiple sites.


The Challenge

Upskilling large volumes of staff members around the correct use of PPE and testing systems and patient flows for COVID positive patients across multiple hospital sites, all while maintaining social distancing. (00:00:45)

The Solution

Tackling these issues involved three key steps:

  • Washable masks and gowns were made for staff to practice correct donning and doffing of PPE so that no resources were wasted
  • Staff were upskilled in ICU practices to support the ICU wards in case there was a surge in cases. This was done through virtual and face-to-face simulation using a manikin set up in a realistic ICU environment, to help set expectations for clinicians who are not used to working in these wards
  • Using simulation for systems testing and patient flow

Social distancing was maintained through the simulation room live feeds and via digital video conferencing technology. (00:02:17)

The Impact

Not only have hundreds of staff members been trained consistently in providing care to ICU patients, but there has also been an increase in staff confidence in their own capability to manage COVID positive patients. (00:08:04)

Tess Vawser

Tess Vawser

Tess is the Director of Clinical Education and Simulation at Epworth Healthcare. She has an extensive background in the establishment and management of hi-fidelity simulation education centers, the mentoring, coordination and training of facilitators and clinical education program development across Victoria.

Her portfolio also oversees the clinical placements of over 3000 undergraduate students, from 14 education providers, across the Epworth hospitals. She has been involved in the design and implementation of national and state health simulation-based training programs along with extensive experience in the development and implementation of team-based clinical skills and simulation programs to all health professionals.

Tess’s main interest is in the provision of interprofessional learning experiences for all levels of health professionals especially utilising clinical skills and simulation modalities. Tess comes from Critical Care Nursing Background in Perioperative and Emergency Nursing. She is a founding member and current board member of the Victorian Simulation Alliance (VSA), a past Executive Committee member of ASSH and has had extensive involvement in Victorian Department of Health’s expert advisory groups across Simulation Based Education and Training, Expanded Settings and Eastern Clinical Training Network committee.

Tess is passionate about sharing her simulation journey in the health industry, from clinical skills teaching, skills mastery, and repetitive practice to reflective practice in team performance and to systems testing.

Video transcript

Melanie Hay:

Welcome to another episode of the AICG Connecting Clinicians: COVID-19 Clinical Governance Series. Today we're welcoming Tess Vawser, who is Director of Clinical Education and Simulation at Epworth HealthCare here in Victoria. Today, Tess will share with us the challenges of implementing a COVID-19 rapid education plan and hospital readiness systems testing across the Epworth sites. Thanks for joining us today, Tess.

Tess Vawser:

Thanks, Mel, and thanks for the invitation to speak. I thought what I'd share with you is the challenges that we've had across Epworth, some of our solutions, and some of our outcomes. So for those who aren't aware, Epworth HealthCare is a not-for-profit private hospital group. We have over 200,000 admissions per year, and we're across 11 sites.

(00:00:45) So firstly, one of our really big challenges knowing that we're going to have this COVID surge training is we really needed to up-skill and train our staff around correct use of PPE. The sheer numbers of this is one of our challenges, and how were we going to do this training. Also, around the need to align with the DHHS' clusters and hospital categories, we needed to understand what was going to be our workforce model, and our needs for the COVID surge. Then also around identifying who needs to be up-skilled, in what areas, and how this was to be done while still socially distancing. And on top of this, the operational issues around preparedness, and how we going to test the systems, especially around the flow and the care of the COVID positive patients.

So if I just go into it looking at those three areas, and what we found worked for us. We have dedicated education areas across all of our sites, and the main acute sites have fully immersive simulation spaces, similar to where I'm standing now. I'll introduce you to it in a moment.

(00:02:17) Firstly, let's talk about the PPE training. So already over 2,000 Epworth staff have been trained in COVID-19 related PPE, which is personal protective equipment. Donning, which is putting on and doffing which is taking off. We trained initial staff members as being PPE spotters. We gave them stickers to wear while they're on the wards, they're bedside Clinicians. This spotting training was focused on ensuring the safety of each staff member by observing the donning and doffing process of all staff in the area. Rolling out the PPE training we used simulated masks. We had a lot handmade, which was lovely, by volunteers in our community. We used washable long-sleeved gowns. This was really important to us because we would have to protect our precious PPE that needed to be used in a clinical environment.

I was a member of the PPE task force, and I had the education portfolio on that also, which was a group-wide task force, really knowing right down to how many pieces of masks, gowns, equipment were around and where we were tracking the training. This was terrific in the sense that if we knew we had a short supply coming up, and state-wise there were supply shortages, and what the challenges would be around moving towards maybe from the disposable gowns to reusable washable long sleeve gowns. We used to have lots of the doffing around tie back face mask, now they're ear loops. So we could be on the forefront of knowing what the challenge would be around new types of disposable equipment that was coming in for the training. So that's been a great success for us across Epworth.

Also, secondly, there was an up-scaling in surge training for our ICU and support streams. So obviously we have many, many qualified and really highly trained ICU nurses and doctors and allied health physicians that we needed to look at up-skilling and support if we have this influx of ICU patients across the board. So we've been able to train over 400 nurses especially to help in this support role. So we developed blended learning programs to support this where you're using virtual sessions face-to-face, and most importantly, it was around the simulation that we developed. Then these staff then were then able to do some supernumerary in the department work.

So here you can see an ICU set up here now. We have these setups across our acute sites, basically around for care of the ICU patient, inline suctioning, how to prone an intubated patient. So there's this specific training around that, and so for the staff member who was coming as a support nurse into the ICU, it wasn't too daunting for them to come in. So this is our simulated ICU patient connected to the ventilator and the monitor, as you can see with all the lines. We've also done a lot of training around our anaesthetic, intubation, ED, ICU medical teams around the specialised intubation techniques used, especially for the COVID positive patient. It's all about staff safety.

The other challenge around all of this training was the masses of the numbers we had, but then we had to keep in mind the social distancing. So we're able to utilise our already in house facilities. We have live feeds for the simulation into multiple rooms. So we'll have the cameras here live feeding through, and to be able to do live debriefings, and talk about team behaviours. Also, there's now the ability with Zoom and we can Zoom across sites, and the other video conferencing capabilities. So that's been pretty amazing that we've had that capacity now. We've always had it to a small degree, but now it's utilised at increased capacity. We also utilised the opportunity so we would do the staff PPE training in our simulated gowns and masks, and we would bring them into the face-to-face environment in their PPE and put them in, so there can be that really close up within the simulations because obviously the anxiety level was quite high initially, over the first six or seven weeks, around our social distancing.

The third main thing that we looked at also was while still trying to keep everybody safe we needed to test our systems, or our patient flows, through our hospitals. So initially we started by just putting a simulated patient, or myself in a bed and being able to see how we would flow that patient through. So it's been terrific around helping us test and help modify what would have been a hospital-wide patient protocol that was paper-based and is now being tested utilising simulation.

(00:08:04) Our main outcomes are around the volume of staff that we're able to engage and train across multiple sites. We're using real-life safe systems testing, and we're refining the protocols. We've increased our staff's confidence in their capability to manage the COVID patient at all of our Epworth sites. We've got consistency in our education and training, and certainly utilising systems testing with the simulation modalities has really been adopted, and we've gained a wider acceptance amongst all staff and executives around systems testing using simulation.

So, I suppose I'm here to say that simulation is more than an educational tool. Don't forget to use it for systems testing. As Confucius says, I hear and I forget. I see and I remember. And I do and I understand. Thank you.

Melanie Hay:

Thanks, Tess, that's fantastic. Thanks so much for joining us today. We'd just like to take a moment to also thank the wider staff at Epworth HealthCare for their hard work and caregiving during this time.

So we'll continue over the coming weeks to bring a series of clinicians together across the country, here and in New Zealand, to share their clinical governance COVID-19 challenges, but also really looking at what challenges and solutions have been implemented which are likely to stay post-COVID-19. So if you'd like to become involved please reach out either via, or via our website.

On that note, until next time, stay safe and Kia Kaha.