Simulations and Box Plots

First, I want to thank Mithra for presenting in Dr. Kahol's absence. The study and innovations of simlations in the periop (surgical) areas is very interesting and obviously showing a marked improvement in confidence and ability. But more interesting was the effect of stress or cognitive noise in the performance and concentration for the task being carried out. It has been known for years that fatigue, stress and outside distrations impact the performance in the periop environment but I have never seen a means to research and study. The EEG cap sounds intriguing but more importantly, having found physicians willing to wear it is even more intriguing.

As you heard, Banner Health has a brand new Simulation Center. The Sim Center is not a virtual simulation center. There is over 50,000 square feet of physical simulated hospital space including a periop (surgery) room equipped with the bed, anesthesia machine, lighting, equipment and a patient (mannequin); an acute area that can simulate ED, ICU, Med Surg and a Labor and Delivery area. The attitude and expectations of the evaluators in the center is to have participants dress and act the part. The hi-tech mannequins are not to be called mannequins. They are to be called patients. The clinicians going through the simulations are required to dress in their appropriate scrubs, wear their stethoscopes, etc. It should look and feel like you are in the real enviornment. This Sim Center is a great tool for clinicians either entering into the clinical world for the first time (new graduates) or for experienced clinicians wanting to change their clinical focus and learn a new area of medicine but the Sim Center by itself can't gather the information presented. What's missing in the Sim Center lies in the research being done at ASU but what's missing in the research is the integration of workflow which is what the Sim Center will hopefully excel in. Although workflow doesn't sound exciting, it has been shown to be the key to adopting any changes in healthcare. Understanding how to perform a procedure is just one piece of a clinician's day. Knowing how to survive and be the most effective in getting through your day is workflow. Just as a "take home" model is being explored for laparoscopy simulation, it would be great to expand simulation into a workflow dialogue and help clinicians play this over and over to give them confidence to not only do a procedure but also document and interact with the patients in a timely and effective manner. There is significant stress with clinicians on their first few days following orientation when faced with a fully digital facility. Their workflows change overnight. In the absence of an EMR, clinicians spend a great deal of time tracking down information. In a digital environment, information is readily available and efforts for finding the paper chart and organizing their day around others using the paper charts disappear. What clinicians may have been doing for years completely changes in as little as one day when they enter into a fully digital environment.

Mithra introduced a new type of chart (box plots) which I have not seen before and took the time to explain the charts. I have since searched and read about box plots. There is another name for them called Box and Whisker Plots. One website I found helpful is: http://cnx.org/content/m10215/latest/  because it shows the raw data and explains how the 25th, 50th and 75th percentile are displayed as well as the boundaries of the whiskers and their meaning.
Posted by Debbie Carter