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Mrs ARMITAGE (Launceston) - Madam President, recently I was fortunate to attend a Defence Reserves Support Council event at the Launceston General Hospital where I met Craig Shennan, who is a life support coordinator at the hospital and he introduced me to the hospital's most patient patient named Nigel. However, Nigel is not your average patient: he volunteers to have needles poked into him without complaining and treatments tested on him on a daily basis. He is actually responsible for training the LGH staff.

At the Launceston General Hospital a code blue event can be defined in simple terms as a clinical response by healthcare professionals to medical emergencies arising within the hospital's area of responsibility, essentially within its four walls.

Emergencies can vary dramatically from simple clinical patient deterioration to cardiac pulmonary arrest severe trauma presentations. All emergencies by nature are time-critical and are extremely stressful to the health-care professional in terms of delivery of timely life-saving treatments. This also applies to the patients and their families who expect and demand expert prioritised emergency care for their loved ones. The requirement for a simulation centre was needs based to address these issues. A business case was prepared on 16 December 2008 and a simulation and training centre became operational on 2 March 2009. Infrastructure, mannequin and resources detailed in the business case were funded from the LGH private patient plan.

The Launceston General Hospital Simulation and Training Centre aims to facilitate educational and learning programs for acquisition and maintenance of clinical skills for nursing, medical and allied health staff within the hospital and the primary health sites across the Northern Area Health Service. In addition, it is intended to augment communication and clinical skills between the post- and undergraduate health-care professionals during simulated scenarios.

Nigel is a mannequin, or human patient simulator, that produces life-like scenarios and is reactive to the effect of drugs and physical manipulations. Nigel is able to physiologically and clinically replicate critically ill patients by way of computer controlled inputs and outputs to assist with learning. He actually looks like a real person and he can talk.

From a different room he can speak, he can react and the people working with him actually believe after a while that he is a real patient.

Ms Rattray - Does he say 'ouch' when they put the needle in?

Mrs ARMITAGE - He does. In the past I have held the simulator's hand and he said, 'You are holding my hand too tightly'. It is quite interesting. The person working with him can make the people working on him feel as if he is a real patient. The simulation mimics the reality of a clinical environment which is designed to demonstrate the procedures, the decision-making and the critical thinking through scenarios and role play. The participants become totally involved in the scenario believing the events are real and consequently the events become real life and participants display critical thinking abilities under duress in a safe environment where no harm can be done to the patient.

Interestingly, the simulation that I attended was of a soldier who had trodden on a mine and he was in a critical condition with chest and head injuries as well as an amputation. You found yourself, although you were only watching, totally immersed in the situation believing it was real as you watched the staff treat the seemingly injured man. Following the treatment there is a debrief, a one-time, semi-structured conversation among the health professionals who have participated in the simulation activity, which provides the opportunity for reflection, feedback and discussion about their learning and their situational experience.

The debriefing is just as important as the actual simulated scenario, as it enables critical reflection of how they felt and found their shared experiences and how this impacted on other members of the team. This collaborative learning process improves the teamwork, the quality of patient care and the health outcomes. It is aimed at training medical, nursing and allied health staff to ensure the right staff to the right patient at the right time. The objectives are educational and skills training focused towards recognition of the deteriorating patient, coordination and control of code blue database in order to audit and redirect training on an as-required basis where deficits in knowledge, skills and attitudes are identified and rectified. It is also critical incident debriefing of emergency scenarios that is maintained to ensure the patient and staff safety but, interestingly, there are measurable outcomes attributed to the simulation training.

There is evidence that in-hospital cardiac arrest survival rates are improving by early recognition of patient deterioration and there is ongoing positive feedback that staff are now more confident in life-saving roles evidenced by satisfaction feedback surveys and improved patient survival rates. Interestingly, the death rate arising from code blue has fallen steadily since 2009. There is a shorter length of stay, and we all know that is important in the hospital, and decreased acute-care hospital admissions. There has also been a reduction of unexpected critically ill ICU admissions from the wards by better training and increased awareness and surveillance of high-risk patients.

The use of simulation has grown steadily across the Northern Area Health Service since the centre opened in 2009. The benefits of partaking in training at the simulation centre are that participants can observe other health-care professionals, managing clinical scenarios and as a result they learn from the shared experience in a safe, non-threatening environment where, as I said, no harm can be done to the patient.

The mission of the centre is to train individuals to assess, reflect and improve their performance in these situations. To do that, particularly challenging events are created and the participants are subjected to conditions that may exacerbate the likelihood of errors and lapses in performance. This is where simulation is particularly useful as we learn from our mistakes and those of others, thus better preparing our work force to deal with these high-stress situations should they ever occur in real time.

Debriefing in a non-judgmental way provides multiple aspects on how the situation was actually handled, what was handled well, what could have been done differently and what would you change if you could do it again. This opens up different ways of thinking and communicating and therefore broadening the learning experience greatly for participants. Observers often report how valuable observing was as they were not under scrutiny and pressured to perform, allowing them to note and reflect on others' behaviours and communication strategies which they in turn adopt and adapt to achieve optimum performance under similar circumstances.

Simulation is an extremely valuable tool which facilitates learning, skill enhancement and collective team performance of health-care professionals which ultimately influences positive patient outcome.

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