Tag Archives: Virtual Reality

Case Study: How Carle BroMenn Medical Center is Using VR to Advance Sepsis Management

Carle BroMenn Medical Center

As virtual reality continues to grow and become a mainstay of healthcare education and training, its uses are being continuously iterated and researched. 

Many academic institutions have rapidly adopted this technology and are using it to support students’ knowledge application, prepare them for clinical placements, or assess their skills. 

As those students graduate and head into practice, they may anticipate and increasingly expect healthcare systems to already use this technology as an adjunct to their training programs. In this way, VR can be a helpful addition to the recruitment process, using standardization to assist in decision-making and showing candidates the innovation and support they can expect at the outset. However, the uses of VR in health systems reach far beyond recruitment. 

Carle BroMenn Medical Center spoke with OMS to discuss their implementation of VR to bolster staff education and positively impact patient outcomes (video above). 

Sepsis Case Selection

Sepsis is a serious condition with cases that have been on the rise nationally for many reasons, per The National Institute of General Medical Sciences, which reports that approximately 1.7 million adults develop sepsis yearly and states it is a leading cause of death in hospitals. 

The symptoms of sepsis, particularly in the early stages, can be seen in other, often more common conditions, making it difficult to identify quickly. Additionally, anyone can be affected by sepsis across a hospital system, making it an important piece of clinical knowledge for everyone caring for patients. 

While many people who develop sepsis can have a full recovery, others may have lifelong consequences as a result. The intensity and complexity of treatment can place an increased financial impact on healthcare systems, making sepsis potentially costly for both patients and hospitals. 

While life-threatening, signs of sepsis, when caught and treated early, can mean better potential outcomes for patients. 

In order to support improvements in the recognition and management of sepsis across departments, the team at Carle BroMenn Medical Center decided to utilize virtual reality as an innovative way to provide education and training to their clinical staff on the early recognition and treatment of sepsis. 

Angelia DeWeese, Simulation Education Specialist, said of the choice to target sepsis treatment:

“We are looking for improved patient outcomes. That’s why we’re doing this – the patient is at the center of it.” 

Implementing VR – The Pilot

Following their research on virtual reality for their use case, the team at Carle BroMenn Medical Center chose to work in partnership with Oxford Medical Simulation (OMS) to bring an immersive sepsis case to life for their staff. 

The breadth and depth of the scenario library, the automated feedback, the robust and immediate data provided by the platform, and the collaborative and responsive nature of the OMS team were key features for the team at Carle in selecting their VR partner.

Virtual patient with clamminess

Once a determination had been made about the use case, the teams at Carle BroMenn and OMS worked together to develop the corresponding learning objectives and match the scenario exactly with the protocol of the hospital system, ensuring nurses were receiving standardized, comprehensive training specific to the facility. 

The initial implementation of VR included sepsis training for nurses in both the Emergency Department and the Intensive Care Unit. 

To start their use of OMS, nurses first participated in a pre-brief that included an orientation to the equipment, then completed VR training sessions. While the VR scenarios themselves take approximately 20 minutes to complete, training sessions lasted for up to two hours to accommodate orientation, the potential to repeat scenarios, facilitator feedback, and post-VR surveys.  

The educators at Carle BroMenn decided on a benchmark pass rate for the scenario which they determined would fulfill both goals of demonstrating competency in the management of a sepsis case while providing room for learners to familiarize themselves with the VR modality to facilitate an overall positive experience. 

Learners completed a questionnaire prior to and following the completion of their scenarios. Additionally, between scenarios, learners received immediate, automated feedback from the platform followed by a debrief with a facilitator, so that they were able to take the feedback and immediately implement it back into practice. 

The initiative aimed to bring sepsis training to the forefront of nurses’ minds, with the goal to improve the time to recognition and early treatment of sepsis to positively impact patient outcomes. 

Did sepsis management improve? – The Results & Impact

The team at Carle BroMenn Medical Center looked at several metrics related to the sepsis case.

person in headset holding laptop with VR simulation score

The OMS Score

The scoring system generated by the OMS platform is weighted based on clinical importance of the actions the learner takes, how they have prioritized these actions, and how they’ve worked as a team. For example, if a critical component of care is not completed efficiently or a safety flag is missed, it is not possible to receive a high score for that attempt. 

In addition to the percent score provided by the OMS platform, evidence-based feedback is presented to the learner, as well. This feedback provides learners with insight into the actions they performed well and where there is room for improvement, alongside rationale for processes important to the case. 

Data amalgamated by the platform gives information to both learners and facilitators about individual or group-based performance – educators at Carle BroMenn reported that OMS was easy to use, and they utilized the automated data provided by the platform to identify trends or gaps, and continue to adjust their education to close any gaps in knowledge. 

From the first attempt to the last attempt, learners demonstrated an improvement in scores by approximately 22%, going from an average first score of nearly 61% to an average final score of just above 83%. 

Self-perceived Confidence & Competence 

Additionally, nurses reported an increase in their levels of confidence and competence in caring for a patient with sepsis. 

Angela Turner, a Nursing Professional Development Specialist at Carle BroMenn, said of the impact that VR has had for learners:

“[VR] allowed [learners] to not only practice taking care of patients in a safe environment, but also allowed them to try a different modality, make mistakes within it, but know it’s safe and they’re not actually doing patient harm.”

On a 10-point scale, learners reported an average self-perceived level of confidence at 6.6 before engaging in VR simulations. After learners had the opportunity to conduct VR scenarios around sepsis, the average level of self-perceived confidence increased to 8.4.

With regard to self-perceived competence, learners reported an average score of 6.8 out of 10, pre-VR. Following the experience with VR simulation, learners later reported an average of 8.4 in their scores – nearly a 2-point increase in each category. 

One participant, Sarah Huber, Quality Outcomes Coordinator Surgical Nursing, said of her confidence in managing sepsis after using OMS, “…Doing the VR did make me feel more confident in treating sepsis, and…the biggest reason is because of the feedback.”

Another learner, Kim Poling, RN2 on the Progressive Care Unit, noted that she took away a better understanding of roles of other nurses in different departments, stating, “As an inpatient nurse…there are steps that I don’t usually see that I think I would be more aware of because of the sepsis training.”

Overwhelmingly, learners enjoyed the VR experience and reported increased levels of self-perceived confidence and competence in caring for patients with sepsis, learning interventions they can implement as soon as they return to the floor.  

Facility Metrics

As this work was focused on improving patient outcomes, the team at Carle BroMenn also looked at a set of real world measures that provided a percentage score for the management of sepsis across the hospital. The goal set was 75% for the facility.

During the months of February and March, performance scores averaged 49.5%. Following the use of VR within the Carle sepsis initiative, April and May showed scores of 88.7% and 89.0 % respectively. 

As a Nursing Professional Development Specialist, Angela Turner, noted in conversation with learners following the use of OMS: 

“Their scores moved, but it was bigger than that. Even in conversations with our learners after doing VR, as we were talking through, ‘What does sepsis really look like in real life?’…They could speak to, ‘These are all the things I would do’…and that’s what we were ultimately after – is that it translated.”

Medical chart guidelines displayed next to virtual nurse

What’s Next for the team at Carle Health?

Learners were able to make mistakes in a safe environment that allowed them to effectively improve their processes and practices while engaging in the critical thinking needed to effectively manage emerging conditions like sepsis. 

Just because nurses may work in the same hospital or facility does not mean they will have matching responsibilities, and with the completion of a holistic scenario around sepsis management, learners could walk away with a deeper understanding of the entire process of care, from start to finish. 

With VR, learners are able to practice their skills in alignment with hospital policies and best practices in a safe environment, and have another learning experience to ultimately impact patient care. 

With such positive results, the team at Carle BroMenn has already expanded the use of OMS for other initiatives, including catheterization training with the urology clinic, and the team has plans to continue VR sepsis training with Carle Foundation, at a system-wide level.  

As Simulation Education Specialist, Angelia DeWeese, notes: 

“This was also a system initiative for Carle Health, so I am excited that we have done this at a facility level, but also it’s opened up the door for our system to be looking at this too. For that opportunity to impact…outcomes from a system perspective is exciting.”

Additionally, Carle BroMenn Medical Center is excited to expand their use of VR with additional scenarios that they may use with new graduates, including other clinical topics to bolster continued education of new healthcare professionals. 

Interested in trying VR sim? Arrange a free demo with us today.

Changing the Face of Education: Virtual Reality in Curriculum

virtual patient in outpatient room
virtual patient in outpatient room

In healthcare education, students often must retain a hefty amount of information, and on top of that, they must build psychomotor skills they can take with them into clinical practice. 

Simulation is a well-known method to begin bridging the gap between knowledge and practice, and while it certainly has a place in healthcare curricula, it also has its limitations. 

Namely, physical simulation is resource-intensive. It requires significant planning, coordination, and it requires a lot from the faculty running the simulation, as well. There’s also the matter of finding an accommodating space and dedicating the time to execute an effective and smooth simulation. 

To achieve similar outcomes at a reduced cost, virtual simulation can be a valuable addition to the teaching modalities used to hone and develop skills like clinical reasoning and decision making. 

As is true of any progression within a curriculum, thoughtful and strategic placement of virtual reality can result in the best outcomes for both faculty and students. 

Integrating VR into a Curriculum

While counterintuitive, it may be best to start at the end – in other words, it’s important to begin with a firm understanding of the expected learning outcomes to determine where VR can best suit learners’ needs. 

Scenarios should be matched to the learner level and, ideally, align closely with the didactic content of the course.

In-headset using VR

Authors at Johns Hopkins University did just that, and they created a roadmap with 4 areas of focus to define the optimal way to add virtual reality into a curriculum. 

Orientation

The journey begins with an orientation process which should serve to familiarize both learners and educators with the platform they’ll be using. 

Faculty can get an understanding of the scenarios and the data provided by the platform to give them all the tools necessary to leverage the VR experience. 

Learners, in turn, get a chance to navigate the platform, and they’ll get the opportunity to navigate the scenario, as well. This way, learners can place their focus on the task at hand when in the scenario rather than on troubleshooting or setup. 

Pre-brief

Next, a pre-brief can be used to get students in the right mindset before entering VR. In the case of JHU, they took this time to discuss concepts like psychological safety and confidentiality prior to beginning the virtual simulation. 

Here, important concepts can give learners the background information or context necessary to optimize the experience. This can include anything from the rationale for virtual reality to reading materials to relevant information regarding the upcoming case.

Virtual patient with clamminess

The Scenario

Once the pre-brief has been completed, learners can enter the virtual simulation and complete the case. It’s entirely up to the academic team to determine the length of time learners can access these scenarios or the benchmark score they must achieve in order to demonstrate meeting the learning objectives. 

OMS scenarios take approximately 20 minutes to complete, and faculty can limit the amount of attempts learners may take; although, an ability to repeat as much as needed may be a benefit to more deliberate practice. 

These types of decisions depend largely on the learning objectives and goals created by the instructors, which is another reason why beginning with predetermined goals can be so beneficial in choosing the right course of action in implementing virtual simulation. 

Once learners complete the scenario, one of the most important components of simulation-based learning is next – the debrief. 

Debrief

Debriefing is an opportunity to provide learners with feedback on their performance, which can make a big impact in overall learning. Traditionally, debriefing takes the form of synchronous, small group-based discussions, led by an experienced facilitator. 

With virtual reality, this can still be the case. Additionally, scenarios may come with automated feedback, providing learners a chance to self-debrief before entering into a group discussion. Feedback with OMS is based on best practices and provides rationale to learners on concepts relevant to the case and appropriate actions to optimize patient care. 

It’s important to take into consideration the perception of VR that learners have, so taking their feedback can help make decisions around the implementation of VR, as well. 

Educators must also have their feedback considered, as they will be the people largely putting the time and effort into the initial curriculum mapping that takes place. 

Adapting VR to your Curriculum

Armed with your learning objectives, you’re likely to find a scenario that aligns with your needs in the OMS library of over 240+ scenarios. 

However, if you’re not able to find what you need or if you’d like to make even the slightest of adjustments to an existing scenario, you can take the creation of the simulation into your own hands.

OMS Create dashboard

Maybe you’d like a vital sign to read differently or you need a virtual patient to have a different response – this can all be done via the no-code authoring platform, OMS Create, giving you the chance to make a VR experience that gives your learners exactly what they need. 

Building, changing, and progressing a curriculum is no easy task, and it requires a lot of effort and planning to make it happen, but with the right tools and goals in mind, you can seamlessly add virtual reality into your curriculum to bring an innovative and informative teaching modality to your learners. 

Interested in trying VR sim? Arrange a free demo with us today.

OMS for Interprofessional Team Building

VR scenario manual pulse
VR scenario manual pulse

Building a safe space for a working environment is imperative to interdisciplinary team success in healthcare settings. 

Team building exercises are often done in person, and as scheduling across multiple disciplines is difficult, it can be few and far between for everyone on the team to come together at the same time for team-focused activities. 

VR can be used as a way to connect the interprofessional team from any space, providing similar benefits to that of in-person team building simulations. 

OMS Interprofessional Scenarios

OMS offers a suite of multidisciplinary scenarios that encourage teamwork, communication, and collaboration for safe and effective patient care. 

No matter where your learners are, they can enter the same simulation with their colleagues to exchange ideas, learn about other roles, and gain a deeper understanding of the intricacies of interprofessional teamwork. 

Together, learners examine, diagnose, and come to decisions on how best to treat patients who are acutely unwell.

These scenarios have a direct focus on team-oriented decision making, critical thinking, communication, and clinical reasoning through acute situations including (but not limited to): 

  • Advanced cardiovascular life support (ACLS)
  • Diabetic ketoacidosis
  • Pulmonary edema
  • Anaphylaxis
ACLS virtual simulation

Beyond what is completed in the scenario itself, learners also get the opportunity to debrief as a group, opening up a dialogue on where the team performed well and which areas have room for improvement. 

Interprofessional roles in scenarios

There are two main types of roles that both learners and trainers or faculty can take on in the simulation – active and observer. 

Active roles include the lead role and the assisting role, who both play active parts in the progression of the scenario. These learners directly communicate with one another to gather relevant information, perform tests and measures, interpret results, and conduct interventions. 

In order to complete the scenario and effectively manage the care of the patient, learners must collaborate to distribute tasks and maintain open communication throughout the simulation. 

This delineation of roles allows for one learner to take on a leadership role within their team, practicing delegation, just as interprofessional teams work together in clinical settings.  Denoting roles can also be beneficial in the understanding of roles and responsibilities of healthcare professionals from other disciplines. 

Observers, on the other hand, have the opportunity to get a view, from any angle, of how the scenario is unfolding and how the team is working together. This can inform and provide greater context for debriefing discussions amongst the team following the simulation. 

Learners or faculty can take on any role, depending on the goal of the scenario and learning objectives, and with OMS Create, faculty can control the patient’s actions, speech, or vitals just as they can in physical simulation. 

If for any reason, planned or unplanned, one participant exits the scenario, roles can be changed mid-simulation. For example, if you’d like to have one learner begin in the assist role and later take on the lead role, that can be planned for prior to entering the simulation. 

In OMS Interprofessional scenarios, learners have the opportunity to come together from across a wide range of disciplines to work as a team with a focus on crisis resource management, teamwork, and communication skills with their colleagues, reflecting the everyday work done by interprofessional teams across healthcare systems.

Team-based feedback

Similarly to single player scenarios, OMS Interprofessional simulations automatically populate with feedback upon completion of the scenario and self-guided reflective questions. 

However, the feedback provided for multiple participants is team-based, so learners can continue working as a group as they debrief. 

virtual debriefing room with feedback and learners

As expected, feedback details areas that went well during the scenario and where there is room for improvement of future performance. This evidence-based feedback also provides learners with rationale, giving a more robust explanation of why certain actions are important and how those concepts relate to practice. 

Additionally, a scenario timeline is constructed and shown to the learners. This timeline contains timestamps for actions taken during the simulation, as well as identifiers for who took which action, providing a visual representation of how the scenario unfolded. 

Finally, learners can go back to review reports that were conducted during the simulation. This may include any imaging, lab results, or guidelines that were relevant for the context of the scenario. 

How one university encouraged interprofessional collaboration with OMS

NOVA Southeastern University Health Professions Division created an Interprofessional Education Day utilizing OMS Interprofessional scenarios. 

They brought together over 2,000 students, faculty, and staff from over 16 disciplines as a part of this day to encourage collaboration and deeper understanding of the interdisciplinary team. 

Prior to the IPE day, faculty recorded a scenario that brought together one student each from pharmacy, medicine, and physician assistant programs. Together, they entered an OMS Interprofessional scenario and collaborated on the treatment of an acutely unwell patient.

Their entire experience was recorded, and on the IPE day, groups of learners were able to view the recorded simulation and debrief on what they observed. 

This particular experience made for rich debriefing discussions, as an incorrect medication was administered during the scenario. This not only brought about discussions on checks and balances for medication administration, but it also encouraged a meaningful discussion on psychological safety at work and speaking up within a cross-functional team to ensure patient safety at every stop.  

Interprofessional scenarios can accommodate multiple learners in each scenario, and for some, that can mean having a classroom of learners participate in the same simulation, at the same time. From three to 300 to 2000 – there’s a way for everyone to get involved and benefit from interdisciplinary team-building simulations. 

With OMS Interprofessional scenarios, learners enter the scenario together, and they exit the scenario together. As a group, they are responsible for the outcome of the simulation, and they are able to take time following the scenario to engage and discuss with one another about how they performed as a unit to positively impact the patient. 

These scenarios foster interprofessional communication and collaboration in a psychologically safe environment, encouraging learners from all healthcare disciplines to come together and build the foundation for interprofessional care. 

To learn more about the ways in which you can use interprofessional scenarios to foster collaborative interdisciplinary teams, set up a time for a demo here.

Interested in trying VR sim? Arrange a free demo with us today.

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