In those first four minutes of a code blue, the person directly caring for the patient could determine the outcome
Call of Duty
Spearheading the simulation program at her hospital, Dr. Tania Sullivan is helping health-care providers hone their skills and improve patient outcomes
John might be made of plastic, but he’s one of the most life-like mannequins you’ll find in Nova Scotia. His skin is soft and warm to the touch, his eyes blink, and he can breathe, bite, groan and vomit on command – mimicking the very real patient behaviours that physicians and other health-care providers see every day.
He’s a valuable member of the mannequin family that emergency physician Dr. Tania Sullivan uses for medical simulations at St. Martha’s Regional Hospital in Antigonish, N.S.
Dr. Sullivan grew up in Joe Batt’s Arm, a tiny outport community on Fogo Island, N.L. “I came to St. FX University as an undergrad,” she said. “Antigonish was very big to me. I remember thinking what my back-up plan would be if I got lost.”
She went on to study medicine at McMaster University, but returned to Antigonish in 2006 to start a job as an emergency physician. She and her husband have raised their five kids in the community. “We came back to Antigonish to be part of a community. It’s an amazing place to live and work.”
Creating a simulation program at St. Martha’s was not part of Dr. Sullivan’s original plan. The idea came to her gradually, after working the night shift for many years and realizing that simulation training could help her and her colleagues hone their skills for dealing with emergency situations.
“Overnight, you’re the only physician and you’re responsible for all the emergencies in the hospital,” said Dr. Sullivan, who is now site chief of St. Martha’s emergency department.
“You’re often working with different teams every night. I found myself going to code blues [when a patient is found without a pulse] and thinking, I wish we could go through that again to make it better.”
With that in mind, six years ago Dr. Sullivan and four nursing colleagues started doing practice codes in different units of the hospital. It allowed staff to practise what she calls “halo events” – rare but deadly situations that can strike a patient with little warning.
“We wanted to foster a culture of growth and learning that would help staff feel prepared for emergencies and have a better sense of their roles,” Dr. Sullivan said.
In 2014, she took simulation leadership training at Dalhousie University. In 2017, she followed that up with more training at the Boston Center for Medical Simulation, a leading institution in the field.
Today, Dr. Sullivan works full time as an emergency medicine physician and site lead at St. Martha’s, while also devoting as much time as she can to the simulation program. She’s not paid for that work but sees how valuable it is for her colleagues and, ultimately, for patients.
“Recently, we did a simulation in our Progressive Care Unit, a step down from the ICU,” she recalled. “We had the mannequin code on the floor. Instead of wasting critical time to move him onto a bed, we started CPR on the floor. Six weeks later, I was called to the same unit and when I got there, they’d started CPR on a patient who coded on the floor. Some of the same staff had been there for the mock code. An hour later, the patient was sitting up in his bed eating toast.”
The simulations aren’t just for doctors and nurses – any health-care provider, medical learner or professional who sees patients at the hospital can participate. “In those first four minutes of a code blue, the person directly caring for the patient could determine the outcome.”
Dr. Sullivan said the accessibility of the training has been critical to the program’s uptake among staff.
She’s held simulations in units across the hospital. “It lets you test the space for any potential weaknesses and at the same time, work on communication among team members. It’s deliberate practice without putting patients at risk.”
After the simulation, the team holds a debrief to discuss each step and what they might do differently next time.
Ivano Cozzi is an emergency nurse who has been a core member of the simulation team from the beginning. “The simulations help you become a better health-care provider, and stay current with new guidelines and protocols,” he said. He helps prep the scenarios and operates the mannequins during simulations.
The mannequins aren’t cheap. Mannequin John is a high-fidelity, computer-operated model that costs about $60,000. As close as you can get to a real human, he reacts to stimuli and can even be given medication through an IV. “We want participants to do things exactly as they would in real life,” Dr. Sullivan said.
“People not only get to practise what medication to give, but they also get to draw it up and give it to the mannequin. You get the procedural proficiency and the muscle memory. The key is to create a psychologically safe environment.” She hopes to add high-fidelity baby and child mannequins to the group.
In the meantime, Dr. Sullivan is sharing her expertise with colleagues at other hospitals in Nova Scotia, including sessions in Sydney and Sherbrooke. “We bring our simulation program and we set it up on a smaller scale, based on the needs at their site. It’s about helping people within the space where they work and the resources they have.”
She’s also hosted sessions for family medicine residents from the North Nova residency program at Dalhousie Family Medicine.
In addition, she enjoys coordinating simulations for students at her local high school. She shows them a photo of an automobile accident and then transitions to the situation in the emergency department. “It’s a real-life experience for students to see the implications of drunk, drugged and distracted driving. It’s about trying to encourage safer behaviours.”
For Dr. Sullivan, simulation is an opportunity to grow and learn as part of a nurturing team. “Lifelong learning is about shared vulnerability,” she said. “I try to model that. Everyone is professional, respectful and capable, and wants to do their best, which creates a really supportive environment.”