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GROUP MEMBERS ROLL NO.
ASHWINI AGAVNE B-02
SNEHA DIXIT B-15
RAVI DONGRE B-16
POOJA BHADANGE B-35
TANVI PAWAR B-43
TUSHAR SADHYE B-47
SANDEEP PAWAR B-56
CHAITALI NERKAR B-57
WHAT IS SIMULATION?
 Simulation is the imitation of the operation of a real-world
process or system over time.
 The act of simulating something first requires that a
model be developed; this model represents the key
characteristics or behaviors/functions of the selected
physical or abstract system or process.
 The model represents the system itself, whereas the
simulation represents the operation of the system over
time.
Why Simulation is Important?
 New policies, operating procedures, information flows and son
on can be explored without disrupting ongoing operation of
the real system.
 New hardware designs, physical layouts, transportation
systems and … can be tested without committing resources for
their acquisition.
 Time can be compressed or expanded to allow for a speed-up or
slow-down of the phenomenon( clock is self-control).
 Insight can be obtained about interaction of variables and
important variables to the performance.
 Bottleneck analysis can be performed to discover where work in
process, the system is delayed.
 A simulation study can help in understanding how the system
operates.
 “What if” questions can be answered.
APPLICATIONS OF SIMULATION
Simulation is used in various fields, such as-
Simulation of Technology for performance optimization.
Safety Engineering
Testing
Training
Education
Video games
Entertainment
Healthcare
Scientific modeling of nature systems or human systems
MEDICAL SIMULATION
 Medical simulation is a branch of simulation technology related to education
and training in medical fields of various industries.
 It can involve simulated human patients, educational documents with
detailed simulated animations, casualty assessment in homeland security
and military situations, and emergency response.
 Its main purpose is to train medical professionals to reduce accidents during
surgery, prescription, and general practice.
 Many medical professionals are skeptical about simulation, saying that
medicine, surgery, and general healing skills are too complex to simulate
accurately. But technological advances in the past two decades have made it
possible to simulate practices from yearly family doctor visits to complex
operations such as heart surgery.
 Disaster response is made easier and conducted by better trained individuals
due to the rapid availability of simulators in schools, hospitals, military
facilities, and research labs.
BENEFITS OF MEDICAL
SIMULATION
Improving Patient Safety
- The ‘Patient Safety’ issue in healthcare systems is a multi-faceted subject that is at
the top of many international healthcare agendas.
- Already identified in the US report, human factors and systems failings are some of
the recognized shortcomings that can compromise, sometimes
fatally, the care of patients.
- Comparing the two industries, the healthcare and the aviation, Sir Liam Donaldson,
Chief Medical Officer of England, cited in his 2009 annual report, ‘That when a
person steps on a plane, their risk of dying in an air crash is 1 in 10 million. When a
person is admitted into hospital, their risk of dying or being seriously harmed by a
medical error is 1 in 300.” Amongst a number of recommendations to the UK
government, he urged, ‘Simulation training in all its forms will be a vital part of
building a safer healthcare system.’
Cont.…
Transforming a ‘Team of Experts’ into an ‘Expert Team’
- Most critical medical errors occur in Acute Care where team effectiveness can be
the pivotal factor that determines the outcome for the patient.
- Until now, very little training provision has existed to rehearse team effectiveness.
- Simulation addresses this training requirement in a way that no other training
methodology can.
- Rare but critical and time pressured events can be recreated in a simulation, so
that protocols can be established and communication problems can be identified
and improved upon.
Cont.…
“Hello, you’re my first patient……” – Preparing for
those First Times
In the current wake of growing public awareness of medical errors and a shift in
both public and professional opinion that it is no longer acceptable to practice
procedures and manage clinical events for the very first time on a patient,
simulation can bridge the gap between text book learning and those ‘first times’. A
simulated environment is safe and risk free for trainees to build their competence
and confidence.
 Capturing Clinical Variation
Medical simulation can capture or represent a wide variety of patient problems
more readily for the learner than otherwise having to wait for a real encounter.
Such simulations will give learners exposure and practical experience or rare, life
threatening patient problems where the presentation frequency is low but the
stakes are high.
Simulation technologies used in medical
education
 Computer-based simulations (micro-worlds,
micro-simulation)
 Virtual environments +/- haptics
 Part-task trainers
 Low-fidelity simulators/manikins
 Simulated or standardized patients
 Hybrid simulations
 High-fidelity (full mission) simulation
 Hospitals are complex production facilities, and it requires a great
perspective to consider future demands on work processes, staffing plans,
optimized patient programmes, reduced waiting times, capacity changes,
etc. What is the significance of variations in operation and recovery
times? Is the operating budget best spent on wards, beds, porters, nurses,
doctors or equipment? How are treatment procedures optimized in the
best way?
 The answers can be found through simulations of the clinical operation
and logistics at the hospital. Simulations can clarify how to use resources
optimally, and what the consequences of capacity changes, such as staff,
areas and equipment, will be. At the same time, the user involvement
seems more present when employees and managers can sit together and
watch an outpatient department and the daily work processes in practice
on the screen.
Discrete Event Simulation in Hospital Supply Chain
Management
 Discrete Event Simulation (DES) is used in the analysis and improvement of
health-care systems.
 It is particularly well suited to tackling problems in healthcare where,
resources are scarce and patients arrive at irregular times (for example, in
accident and emergency (A&E) departments).
 Some of the applications of DES are therefore to forecast the impact of
changes in patient flow, to examine resource needs (either in physical
capacity of beds and equipment or in staffing), to manage patient
scheduling and admissions or to investigate the complex relationships
among the different model variables (for example, rate of arrivals or time
spent in the system).
 DES therefore allows decision makers to effectively assess the efficiency of
existing healthcare delivery systems, to improve system performance or
design, and to plan new ones .
BabySIM
The BabySIM is a realistic, 16 pound model of an infant with correct physiology
and generated reactions to medical interventions. This simulator was created
for life-saving infant care practice. "BabySIM can produce heart, bowel and
breath sounds, including bilateral chest excursion and seesaw breathing.
Simulates:
-Bulging fontanel capability
-blinking eyes with variable pupil size and the ability to tear
-Cooing and crying
-Secretions from the ears, eyes, and mouth
-Responds to airway trauma or obstruction: esophageal, nasal and oral
intubation, and BVM ventilation and laryngoscopic procedures
-Responds to chest compressions, defibrillation and pacing, needle
decompression, chest tube insertion and intraosseous insertion
METIman
The METIman simulator is the most advanced and realistic of all CAE simulators. The
METIman can withstand indoor and outside training simulations and has a large variety
of training in many areas. “METIman’s easy to use learning features are designed for
teaching basic nursing and prehospital skills.
Simulates:
-Suction airway secretions with variable airway resistance
-Aspirate and infuse fluids
-Cricothyrotomy/tracheostomy and bronchial occlusion
-Pacing and CPR compressions
-Responds to defibrillation
-Bilateral chest movement
-Suction airway secretions with variable airway resistance
-Palpable pulse
-Responds to needle thoracentesis and chest tube placement
CAE Fidelis
This pregnant patient simulator is meant for child birthing simulations and is a Maternal
Fetal Simulator. It was created for practice with normal deliveries, emergency deliveries,
as well as births with complications. “Fidelis is the only childbirth simulator with
validated maternal-fetal physiology. The physiological modeling allows learners to
monitor and manage both patients without instructor intervention.
Simulates:
-Static and dynamic cervices that dilate, efface, and station
-Fetus that automatically descends and rotates
-Fetus with soft and firm areas true to life
-Fetus that responds when stimulated with suctioning with an open mouth and nose
-Fetus with attached umbilical cord and attached placenta that is able to be positioned
PediaSim
The PediaSim was created for pediatrics in need of critical care. It is a simulation of a six-
year old child. “PediaSim offers the integrated METI physiology in a smaller practice
patient with full trauma features for both nursing and emergency response.” “PediaSIM
HPS is specifically designed for risk-free practice of anesthesia, respiratory and critical
care. With true respiratory gas exchange, PediaSIM HPS inhales oxygen and exhales CO2,
interfaces with real clinical monitors and responds to oxygen therapy.
Simulates:
-Responds to clinical interventions: chest compression, pacing, defibrillation,
needle decompression, and chest tube insertion
-Airway trauma features: upper airway obstruction, laryngospasm and bronchial
occlusion for intubation
-BVM ventilation and needle cricothyrotomy
SimMan®3G
SimMan®3G is a full size lifelike mannequin that allows for simulation of different
medical conditions to help train those that would need to treat those issues in the real
life. The mannequin works wirelessly and it is self-contained, allowing it to be used in
realistic settings like a hospital, ambulance or military combat environment.
Simulates:
-Airway complications
-Breathing complications
-Circulation Features
-CPR
-Eye movement
-Convulsions
-Bleeding and Wounds
Simulation Projects
“In the Pipeline”
Immersive Simulation for Design and Evaluation of an
Emergency Department IT
 Emergency departments can be noisy and confusing places where
keeping track of patients can be a challenge.
 The goal of this project is to design and test a prototype emergency
department information system with the potential to track ED
patients and improve efficiency and safety, decrease ED wait times,
and decrease preventable injuries to patients.
 The research team will use simulation and cognitive systems
engineering methods to design and test prototype ED information
systems that are based on an in-depth understanding of the activities
of caregivers and staff within the ED.
 They will use a multiphase strategy to model key aspects of ED
activities, iteratively develop prototypes, and assess prototypes in a
simulated clinical environment.
Acceleration to Expertise: Simulation as a Tool to Improve the
Recognition of Sepsis
 Sepsis is a diagnostic challenge and a leading cause of death worldwide.
 Failure to recognize the early signs and symptoms of sepsis and institute
aggressive management significantly increases the risk of death for children
and adults.
 Simulation-based training can accelerate the development of expertise
needed by novice clinicians to quickly and accurately recognize sepsis. By
identifying the unique elements of the expert's approach to sepsis, an
effective, simulation-based approach might become possible. Specifically,
the research team will:-
1. Determine the behaviors that characterize and differentiate the expert from
the novice in the recognition of sepsis at the bedside.
2. Develop and implement simulation-based learning interventions that
accelerate the development of expertise in relation to sepsis recognition.
Improving Cancer Care Patient Safety Through
Pathology Training Simulation
 Uncontrolled variability in diagnostic testing contributes to high rates of error and
increased costs.
 The incorporation of simulation training in pathology residency holds promise for
reducing variability.
 This research will determine whether a simulation-based anatomic pathology
education combined with Lean methods of quality improvement is better than a
traditional apprenticeship for reducing errors in formulating pathology diagnoses of
cancer in major solid organs.
 The research team will conduct a double cohort case-control study in a single
institution by separating residents on the university hospital anatomic pathology
rotation into two groups:
1.An integrated Lean-simulation-based anatomic pathology education track.
2.A traditional apprenticeship track. They will compare resident performance
and patient safety outcomes in oncology for the two tracks over a 3-year period.
Simulation research must address healthcare
training needs
 Improved outcomes
• Fewer adverse events, fewer preventable incidents, fewer
‘near miss’ events
 Increased efficiency of training
• Improved outcomes in same or (preferably) less training time
 Improved use of resources
• Fewer failures, more efficient training, quicker performance
The future of simulation...
 Skills training tool for all disciplines
• Acute care
• Try new techniques and/or equipment
• Patient safety initiatives
• Retraining
 Multi-disciplinary training
• inter-professional communication
• team performance
 Training in decision-making/resource co-ordination
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Applications of simulation in hospital

  • 1.
  • 2. GROUP MEMBERS ROLL NO. ASHWINI AGAVNE B-02 SNEHA DIXIT B-15 RAVI DONGRE B-16 POOJA BHADANGE B-35 TANVI PAWAR B-43 TUSHAR SADHYE B-47 SANDEEP PAWAR B-56 CHAITALI NERKAR B-57
  • 3. WHAT IS SIMULATION?  Simulation is the imitation of the operation of a real-world process or system over time.  The act of simulating something first requires that a model be developed; this model represents the key characteristics or behaviors/functions of the selected physical or abstract system or process.  The model represents the system itself, whereas the simulation represents the operation of the system over time.
  • 4. Why Simulation is Important?  New policies, operating procedures, information flows and son on can be explored without disrupting ongoing operation of the real system.  New hardware designs, physical layouts, transportation systems and … can be tested without committing resources for their acquisition.  Time can be compressed or expanded to allow for a speed-up or slow-down of the phenomenon( clock is self-control).  Insight can be obtained about interaction of variables and important variables to the performance.  Bottleneck analysis can be performed to discover where work in process, the system is delayed.  A simulation study can help in understanding how the system operates.  “What if” questions can be answered.
  • 5. APPLICATIONS OF SIMULATION Simulation is used in various fields, such as- Simulation of Technology for performance optimization. Safety Engineering Testing Training Education Video games Entertainment Healthcare Scientific modeling of nature systems or human systems
  • 6. MEDICAL SIMULATION  Medical simulation is a branch of simulation technology related to education and training in medical fields of various industries.  It can involve simulated human patients, educational documents with detailed simulated animations, casualty assessment in homeland security and military situations, and emergency response.  Its main purpose is to train medical professionals to reduce accidents during surgery, prescription, and general practice.  Many medical professionals are skeptical about simulation, saying that medicine, surgery, and general healing skills are too complex to simulate accurately. But technological advances in the past two decades have made it possible to simulate practices from yearly family doctor visits to complex operations such as heart surgery.  Disaster response is made easier and conducted by better trained individuals due to the rapid availability of simulators in schools, hospitals, military facilities, and research labs.
  • 7. BENEFITS OF MEDICAL SIMULATION Improving Patient Safety - The ‘Patient Safety’ issue in healthcare systems is a multi-faceted subject that is at the top of many international healthcare agendas. - Already identified in the US report, human factors and systems failings are some of the recognized shortcomings that can compromise, sometimes fatally, the care of patients. - Comparing the two industries, the healthcare and the aviation, Sir Liam Donaldson, Chief Medical Officer of England, cited in his 2009 annual report, ‘That when a person steps on a plane, their risk of dying in an air crash is 1 in 10 million. When a person is admitted into hospital, their risk of dying or being seriously harmed by a medical error is 1 in 300.” Amongst a number of recommendations to the UK government, he urged, ‘Simulation training in all its forms will be a vital part of building a safer healthcare system.’
  • 8. Cont.… Transforming a ‘Team of Experts’ into an ‘Expert Team’ - Most critical medical errors occur in Acute Care where team effectiveness can be the pivotal factor that determines the outcome for the patient. - Until now, very little training provision has existed to rehearse team effectiveness. - Simulation addresses this training requirement in a way that no other training methodology can. - Rare but critical and time pressured events can be recreated in a simulation, so that protocols can be established and communication problems can be identified and improved upon.
  • 9. Cont.… “Hello, you’re my first patient……” – Preparing for those First Times In the current wake of growing public awareness of medical errors and a shift in both public and professional opinion that it is no longer acceptable to practice procedures and manage clinical events for the very first time on a patient, simulation can bridge the gap between text book learning and those ‘first times’. A simulated environment is safe and risk free for trainees to build their competence and confidence.  Capturing Clinical Variation Medical simulation can capture or represent a wide variety of patient problems more readily for the learner than otherwise having to wait for a real encounter. Such simulations will give learners exposure and practical experience or rare, life threatening patient problems where the presentation frequency is low but the stakes are high.
  • 10. Simulation technologies used in medical education  Computer-based simulations (micro-worlds, micro-simulation)  Virtual environments +/- haptics  Part-task trainers  Low-fidelity simulators/manikins  Simulated or standardized patients  Hybrid simulations  High-fidelity (full mission) simulation
  • 11.
  • 12.  Hospitals are complex production facilities, and it requires a great perspective to consider future demands on work processes, staffing plans, optimized patient programmes, reduced waiting times, capacity changes, etc. What is the significance of variations in operation and recovery times? Is the operating budget best spent on wards, beds, porters, nurses, doctors or equipment? How are treatment procedures optimized in the best way?  The answers can be found through simulations of the clinical operation and logistics at the hospital. Simulations can clarify how to use resources optimally, and what the consequences of capacity changes, such as staff, areas and equipment, will be. At the same time, the user involvement seems more present when employees and managers can sit together and watch an outpatient department and the daily work processes in practice on the screen.
  • 13. Discrete Event Simulation in Hospital Supply Chain Management  Discrete Event Simulation (DES) is used in the analysis and improvement of health-care systems.  It is particularly well suited to tackling problems in healthcare where, resources are scarce and patients arrive at irregular times (for example, in accident and emergency (A&E) departments).  Some of the applications of DES are therefore to forecast the impact of changes in patient flow, to examine resource needs (either in physical capacity of beds and equipment or in staffing), to manage patient scheduling and admissions or to investigate the complex relationships among the different model variables (for example, rate of arrivals or time spent in the system).  DES therefore allows decision makers to effectively assess the efficiency of existing healthcare delivery systems, to improve system performance or design, and to plan new ones .
  • 14. BabySIM The BabySIM is a realistic, 16 pound model of an infant with correct physiology and generated reactions to medical interventions. This simulator was created for life-saving infant care practice. "BabySIM can produce heart, bowel and breath sounds, including bilateral chest excursion and seesaw breathing. Simulates: -Bulging fontanel capability -blinking eyes with variable pupil size and the ability to tear -Cooing and crying -Secretions from the ears, eyes, and mouth -Responds to airway trauma or obstruction: esophageal, nasal and oral intubation, and BVM ventilation and laryngoscopic procedures -Responds to chest compressions, defibrillation and pacing, needle decompression, chest tube insertion and intraosseous insertion
  • 15. METIman The METIman simulator is the most advanced and realistic of all CAE simulators. The METIman can withstand indoor and outside training simulations and has a large variety of training in many areas. “METIman’s easy to use learning features are designed for teaching basic nursing and prehospital skills. Simulates: -Suction airway secretions with variable airway resistance -Aspirate and infuse fluids -Cricothyrotomy/tracheostomy and bronchial occlusion -Pacing and CPR compressions -Responds to defibrillation -Bilateral chest movement -Suction airway secretions with variable airway resistance -Palpable pulse -Responds to needle thoracentesis and chest tube placement
  • 16. CAE Fidelis This pregnant patient simulator is meant for child birthing simulations and is a Maternal Fetal Simulator. It was created for practice with normal deliveries, emergency deliveries, as well as births with complications. “Fidelis is the only childbirth simulator with validated maternal-fetal physiology. The physiological modeling allows learners to monitor and manage both patients without instructor intervention. Simulates: -Static and dynamic cervices that dilate, efface, and station -Fetus that automatically descends and rotates -Fetus with soft and firm areas true to life -Fetus that responds when stimulated with suctioning with an open mouth and nose -Fetus with attached umbilical cord and attached placenta that is able to be positioned
  • 17. PediaSim The PediaSim was created for pediatrics in need of critical care. It is a simulation of a six- year old child. “PediaSim offers the integrated METI physiology in a smaller practice patient with full trauma features for both nursing and emergency response.” “PediaSIM HPS is specifically designed for risk-free practice of anesthesia, respiratory and critical care. With true respiratory gas exchange, PediaSIM HPS inhales oxygen and exhales CO2, interfaces with real clinical monitors and responds to oxygen therapy. Simulates: -Responds to clinical interventions: chest compression, pacing, defibrillation, needle decompression, and chest tube insertion -Airway trauma features: upper airway obstruction, laryngospasm and bronchial occlusion for intubation -BVM ventilation and needle cricothyrotomy
  • 18. SimMan®3G SimMan®3G is a full size lifelike mannequin that allows for simulation of different medical conditions to help train those that would need to treat those issues in the real life. The mannequin works wirelessly and it is self-contained, allowing it to be used in realistic settings like a hospital, ambulance or military combat environment. Simulates: -Airway complications -Breathing complications -Circulation Features -CPR -Eye movement -Convulsions -Bleeding and Wounds
  • 20. Immersive Simulation for Design and Evaluation of an Emergency Department IT  Emergency departments can be noisy and confusing places where keeping track of patients can be a challenge.  The goal of this project is to design and test a prototype emergency department information system with the potential to track ED patients and improve efficiency and safety, decrease ED wait times, and decrease preventable injuries to patients.  The research team will use simulation and cognitive systems engineering methods to design and test prototype ED information systems that are based on an in-depth understanding of the activities of caregivers and staff within the ED.  They will use a multiphase strategy to model key aspects of ED activities, iteratively develop prototypes, and assess prototypes in a simulated clinical environment.
  • 21. Acceleration to Expertise: Simulation as a Tool to Improve the Recognition of Sepsis  Sepsis is a diagnostic challenge and a leading cause of death worldwide.  Failure to recognize the early signs and symptoms of sepsis and institute aggressive management significantly increases the risk of death for children and adults.  Simulation-based training can accelerate the development of expertise needed by novice clinicians to quickly and accurately recognize sepsis. By identifying the unique elements of the expert's approach to sepsis, an effective, simulation-based approach might become possible. Specifically, the research team will:- 1. Determine the behaviors that characterize and differentiate the expert from the novice in the recognition of sepsis at the bedside. 2. Develop and implement simulation-based learning interventions that accelerate the development of expertise in relation to sepsis recognition.
  • 22. Improving Cancer Care Patient Safety Through Pathology Training Simulation  Uncontrolled variability in diagnostic testing contributes to high rates of error and increased costs.  The incorporation of simulation training in pathology residency holds promise for reducing variability.  This research will determine whether a simulation-based anatomic pathology education combined with Lean methods of quality improvement is better than a traditional apprenticeship for reducing errors in formulating pathology diagnoses of cancer in major solid organs.  The research team will conduct a double cohort case-control study in a single institution by separating residents on the university hospital anatomic pathology rotation into two groups: 1.An integrated Lean-simulation-based anatomic pathology education track. 2.A traditional apprenticeship track. They will compare resident performance and patient safety outcomes in oncology for the two tracks over a 3-year period.
  • 23. Simulation research must address healthcare training needs  Improved outcomes • Fewer adverse events, fewer preventable incidents, fewer ‘near miss’ events  Increased efficiency of training • Improved outcomes in same or (preferably) less training time  Improved use of resources • Fewer failures, more efficient training, quicker performance
  • 24. The future of simulation...  Skills training tool for all disciplines • Acute care • Try new techniques and/or equipment • Patient safety initiatives • Retraining  Multi-disciplinary training • inter-professional communication • team performance  Training in decision-making/resource co-ordination