May 17, 2019

The Simulation and Advanced Skills Center Continues to Innovate

Nurses lead the way in simulated training


Seven years ago, Cleveland Clinic’s Simulation and Advanced Skills Center (SASC) opened its doors, consolidating all of the healthcare system’s simulation activities into a common center offering multidisciplinary training on a broad range of clinical scenarios. The SASC is a thriving center: In 2018, it educated nearly 40,000 learners and offered more than 1,900 lab courses in nine labs, including human patient simulation labs, a wet lab and a robotic lab.


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While caregivers from all of Cleveland Clinic Institutes participate in courses at the SASC, nurses represent the single largest group of simulation users. Last year, more than 25,400 participants were from the Stanley Shalom Zielony Institute for Nursing Excellence.

“The SASC allows nurses to practice in a safe environment, continuing to develop higher level skills, such as hemodynamic monitoring and advanced airway management,” says Leslie Simko, MS, RN, CHSE, nursing senior director and administrator for the Simulation and Advanced Skills Center. “We also encourage nurses to use critical-thinking and clinical judgment, helping them to really think about what they are doing and why they are doing it.”

Six new developments at the SASC

As the healthcare industry evolves, so too does the SASC. Here are a few newsworthy additions to the center’s facilities and educational offerings in the last year or on the horizon:

  • Nursing Lab Renovations – Of the nine labs at the SASC, five of them are nursing education labs. The nursing labs, which were constructed in 2006, will undergo renovations beginning in July to incorporate new technologies resulting in a higher fidelity environment. New additions will include two simulation operation control rooms with one-way mirrored glass, microphones and pillow speakers. A wider doorway will be installed in an adjacent lab to facilitate transfer of beds and larger equipment, resulting in quicker transitions between scenarios and higher utilization.
  • Redesigned Nurse Residency Programs – Cleveland Clinic’s Nurse Residency Program is a one-year competency and simulation-based program to support new graduate nurses and experienced nurses entering a new specialty. Among the changes are development of a new behavioral health track. In addition, all of the nurse residency specialties are beginning to track observable performance metrics (OPMs) during simulations, previously only done by the medical-surgical track. “These OPMs are collected during all of the residency activities, not just simulation, and tracked over the full residency program,” says Nichole Kelsey, MSN, RN, CHSE-A, simulation education specialist.
  • Double Debriefing Trial – Cleveland Clinic is trialing a novel way to rotate 12 learners through a simulation with one facilitator, compared to the traditional group of five to seven learners. With the new method, the group is divided in half: One half participates in the simulation activity, while the other half works on a case study. The groups switch, then rejoin each other for a large group debrief on both activities. The SASC is educating trainers on the new method and working with the residency coordinator and course leaders to create tools for effective note keeping and observations.
  • Added Simulation-Based Competencies – Pediatrics and the Emergency Department conducted simulation-based competencies this year aligning with organizational needs assessments. “Pediatrics is focusing on mental health, and ED is addressing precipitous delivery this year,” says Kelsey. “Each year the scenarios change based on unit-specific needs assessments.”
  • First Responder Courses – For several years, the SASC has conducted first responder courses for all inpatient clinical nurses to reinforce the first five minutes of a patient emergency before help arrives. Last year, the center rolled out an ambulatory first responder course, instructing nurses at all Cleveland Clinic family health centers and outpatient facilities. “The response is a bit different than that of an inpatient facility,” says Brian Kissinger, BSN, RN, department manager for the American Heart Association Training Center. “The course focus is emergency care of a patient in an ambulatory setting until help arrives.”
  • More Multidisciplinary Offerings – On April 19, the SASC hosted an interprofessional education course in collaboration with the Nursing Residency Program, Cleveland Clinic Lerner College of Medicine and Case Western Reserve University. Approximately 70 third-year medical students joined more than 35 nurses and a dozen respiratory therapists for interprofessional training. “This is a gigantic course with significant opportunity for impact,” says Kelsey.

Training others with an eye toward the future

As a recognized leader in simulation training, Cleveland Clinic often shares its expertise outside of the healthcare institution. In the past two years, nurses have presented poster or podium presentations at five simulation-based conferences. Last year, 18 instructors staffed courses at four U.S. Department of State embassy medical staff conferences, where they issued approximately 1,230 American Heart Association credentials to 600 registered nurses, nurse practitioners, physicians and physician assistants.

The SASC continues to look toward the future, considering opportunities such as virtual reality and avatar-based simulation. “The platform would allow us to reach out to other hospitals and facilities,” says Simko. “Using virtual reality goggles, we could be in the same environment, communicate with one another and work together through different patient scenarios.” It’s the perfect pairing of technology and collaboration for the Simulation and Advanced Skills Center, which continues to break new ground in caregiver training.

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