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Mobile Sims Cart: A Homegrown VA Compatible Virtual AV System

By Joseph Ferrand, Telehealth Clinical Technician
Jerome Perry, Simulation Technology Specialist
Trang Nguyen, MSN, RN, Simulation Coordinator and REdI BLS PD/ACLS TCF: SimLEARN Outreach Network
Jane Robinson, MSN, RN, CEN, Systems/Hospital Activation Nurse
LeAnn Schlamb, MSN, Ed. S, Associate Director, Simulation Education, Research, and Outreach

A year ago, the SimLEARN’s Outreach Network (SON) Systems Hospital Activation (S/HA) was traveling the country providing S/HA services to facilities across the country. The team was working with six different Veterans Affairs (VA) facilities in various stages of planning to conduct activation activities. Then COVID-19 began impacting operations at VA facilities across the nation and S/HA on-site activities halted. In pre-COVID-19 days the S/HA team would travel to a facility requesting assistance with the use of systems-focused simulation to evaluate new or renovated patient care areas for latent safety threats prior to opening. In collaboration with stakeholders at the facility the S/HA team would create scenarios to evaluate workflow, patient flow, equipment, and emergency procedures latent safety threats. When the S/HA team had to stop traveling one the sites impacted was the Fayetteville, North Carolina Veterans Affairs Medical Center (FNCVAMC). FNCVAMC was planning to increase the complexity level of their Urgent Care to a full Emergency Department (ED) and due to the rising COVID-19 threat, the need to focus on Veteran care, and to ensure staff safety, they delayed their systems testing planned for March 2020. In September of 2020 the FNCVAMC Urgent Care Leadership team reached out to the S/HA team at SimLEARN to inquire what options were available to support their activation. Specifically, they requested a virtual option due to COVID-19 restrictions on travel and group training. The S/HA team had previously attempted to conduct activations virtually however, they ran into significant barriers with live streaming the scenarios. Not one to admit failure the S/HA team accepted the challenge to collaborate with the FNCVAMC Simulation and Telehealth Teams to create a system that would allow the S/HA team to support the FNCVAMC ED activation. 

The FNCVAMC team partnered with the S/HA team to identify system requirements. It was vital that the system support a constant streaming of video and audio while following Veterans and staff throughout the facility. Other considerations during the development were the ability to capture multiple views, for the remote S/HA faculty to interact with on-site facilitators during the scenario, and for remote S/HA faculty to able to debrief the on-site participants following the scenario. The FNCVAMC team took the lead to create what would come to be known as the Mobile Sim Cart. With no budget available to build the system they used locally available equipment and systems. Applying their experience with telehealth and simulation, Mr. Ferrand and Mr. Perry began collecting the equipment needed to create a cart that would meet the specifications identified by the team. By selecting VA standard computer systems, equipment, and programs the Mobile Sim Cart can be utilized by organizations across the VA.
 
Mr. Ferrand and Mr. Perry spent countless hours constructing and refining the new system. The Mobile Sim Cart was used for the first time during the ED activation in October. Its performance exceeded the team’s expectations, allowing for seamless streaming of activation activities and for the remote S/HA team and on-site participants to communicate successfully. Following the activation activities Mr. Ferrand and Mr. Perry made several enhancements to the system based on feedback from the end users resulting in the current version of the Mobile Sim Cart. The foundation of the system is a government issued laptop capable of accessing the local VA Mobile Device WIFI system. To increase the mobility of the system the laptop was mounted on a Workstation on Wheels (W.O.W). The W.O.W. furnishes the system with a mobile power supply through its external battery source. An external web camera was added to provide increased video clarity and flexibility to obtain camera views. On the Mobile Sim Carts initial outing participants had challenges hearing the laptops built in speakers so external speakers were added. Finally, two monitors were added, one facing the operator and one facing the learners. The monitor facing the operator allows the operator to interact with the remote facilitators. The monitor facing the learners is used during debriefing.
 
Recently, this innovative Mobile Sims Cart has been used to conduct three virtual activations, two at FNCVAMC and one at the Southern Louisiana Healthcare System. The system has expanded SimLEARN’s S/HA team’s ability to provide services. Previously, when the S/HA team offered face-to-face training they encountered a variety of limitations including limited time on site, fixed schedules, the size and specialties of the team members, and no video record for future reference. The transition to a virtual platform has had several advantages for the S/HA program. The reduced need for travel has increased the availability of the team to support activations at more sites. The team now can offer simulations across multiple days and shifts allowing for a more robust evaluation of the unit or clinic’s systems and how they will integrate with the facilities existing systems. By using the Microsoft Teams platform, the S/HA program is able to include representatives for impacted units without them needing to be on site and subject matter experts from around the country that would not be able to participate otherwise. It also limits the impact on patient care by reducing crowding caused by observers and provides more flexibility for use of space. Finally, the ability to record activation activities allows for review of the scenario to identify or clarify latent safety threats that may have been missed. Sites and S/HA team members have reported overall increased satisfaction with this new format. Post COVID-19, SimLEARN’s S/HA will offer a blended format, virtual and face to face. 

COVID-19 has presented challenges to all areas of health care, including simulation-based training. It has forced simulation programs to closely examine their offerings and determine new strategies for delivering training. The Mobile Sim Cart is an affordable, off the shelf solution that is compatible with VA systems. It is a cost-effective way of closing the gap between evaluator and learner. Incorporating this system into a program will allow it to provide virtual simulation-based training solutions. Potential advantages to a program using the Mobile Sim Cart include the ability to provide simulation to more learners at more sites, flexible scheduling, decreased cost related to decreased need to travel, and incorporation of subject matter experts that may not be able to participate otherwise.

For more information on creating your own A/V cart contact Joseph Ferrand (joseph.ferrand@va.gov) or Jerome Perry (jerome.perry@va.gov). For more information on Systems/Hospital Activations contact the SimLEARN Outreach Network at vhasimlearnson@va.gov  

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