On October 22, about 30 members of our IHI Open School Chapter in South Dakota had the chance to participate in a simulation event we called "Fright Night." Our idea was to bring together students from different fields of health sciences and let them work through scary or worst-case scenarios. Students of medicine, nursing, physical therapy, physician assistant, and pharmacy all participated in this memorable event at the Parry Center for Clinical Skills and Simulation in Vermilion, South Dakota. Each discipline brought its own unique expertise, and as students and young health care providers, we need to learn to rely on this expertise to provide high quality care in an increasingly complex world of health care delivery.

We began the evening with the story of Josie King, an 18-month-old who died of dehydration and a wrongly administered narcotic at Johns Hopkins Hospital. Dr. Jeremy Hall, an ED physician and director of the simulation center, facilitated a group discussion about what went wrong in Josie’s case and how this tragedy could have been avoided. It became clear to us that a combination of miscommunication, laziness, and poor listening led to Josie's unnecessary death.

Josie’s story was a meaningful start to the evening. Rather than a general discussion about medical errors and miscommunication, Josie’s story put a face to a problem and helped the lesson sink in.

Next, we split up into smaller interdisciplinary groups of about five people. We went through four different scenarios each led by a faculty member:

The Complex Admission
The first room contained a standardized patient with a fairly detailed admission. We went in to the room one at a time and got the report from the person that went in before us.

At the end, we were able to see how much had been left out from the initial report to the last one. That led to an important conversation led about the importance of relaying information accurately and completely. We learned about SBAR (situation, background, assessment, recommendation) as a means of organizing information so as not to leave anything out.

The ‘Egg-Headed’ Patient
Our second task was to master “Teeter Totter Technology,” a team-building exercise used by the Telluride Association. A long board was placed over a cinder block with an egg under either end of the board. As a team, we had to determine the most effective way to get all five members on the board without letting one end take on too much weight and crash down on the egg.

The exercise was good for loosening people up, building basic trust, and creating an effective process to prevent harm to our egg-headed patients.

The Room of Horrors
In the next scenario, we had five minutes to investigate a typical hospital room and record any errors we discovered.  Obvious errors, like a disconnected breathing tube and a forgotten used syringe, caught our attention. More subtle errors like a misspelled patient name and a catheter bag left on the floor — rather than hooked to the bed — were a few of the horrors we missed.

 
Our discussion about what we missed reminded us both that it is always important to pay attention to the details, and that every member of a health care team can watch for potential harm in a typical patient room.

Cardiac Arrest Caught on Tape
The final scenario challenged our multidisciplinary team to treat our high-tech manikin during a heart attack and subsequent cardiac arrest. The five of us did the best we could to stabilize the patient while we were recorded in the simulation center.

The valuable part of this exercise came during debrief while we watched our performance and received feedback from faculty and students. It was amazing what even a group of first-year students with little health care experience could accomplish when working together. Of course, some of us weren't sure about medication dosages and what medications we could use, but it was really meaningful to watch a group go through that situation and identify areas where they could work better both interprofessionally and as a small team.

Overall, we had great success with our event and we encourage any Chapter with access to a simulation center or similar facility to look into hosting one. . Putting it all together was not as difficult as it may seem; we had only one student coordinator for our “Fright Night.” He met with faculty of the simulation center to discuss possible scenarios, shared these ideas with our Chapter, and then we assigned student leaders and faculty members to each scenario to help facilitate.

You don’t need to be an expert on simulation to create scenarios. As students, we’ve all seen areas in clinical settings that could be improved.  Draw on your own experiences, concepts from the IHI Open School courses, and discussion with faculty and simulation center staff to bring together some ideas.

We would also recommend creating a survey for students once the event is over. As a group dedicated to improving quality of care, it is also our responsibility to simultaneously improve our events and activities, effectively practicing quality improvement within our Chapter itself.

We should also mention that the event provided an excellent introduction to our Chapter for new students interested in a hands-on approach to quality improvement and patient safety. We created a significant amount of hype around our Chapter. Students who participated in “Fright Night” are now more interested in the IHI Open School and participating in future events than they ever were before.

- Scott Stevens, New Student Leader and First-Year Medical Student and Ryan Miller, Chapter President and Third-Year Medical Student