Epworth HealthCare

Excellence. Everywhere. Everyday

Simulated Learning in Emergency

Training for HDR

Yen Tran, Thang Nguyen and Venkata Seshadri

Epworth Radiation Oncology, Melbourne, Victoria, Australia

Introduction

2

• Epworth Radiation Oncology (ERO) commenced

its HDR service in July 2013

• microSelectron® Digital afterloader

• Currently treat HDR vaginal vault patients

• Vaginal CT/MR Multi Channel (VCMC) applicator

• Standard CT/MR applicator set

Background

3

• Likelihood of the source not retracting or source

detachment is very low

• AAPM Radiation Therapy Committee Task Group

No. 59 (Kubo et al. 1998)

• All HDR Brachytherapy services have Emergency

Procedures and protocols in place

Background – Simulated Learning

4

• Epworth Clinical Simulated Learning Team

• Applied in other high-hazard professions

– Aviation,

– Nuclear power

– Military (Ziv et al. 2003)

• Rapidly developing discipline that provides safe

and effective learning environments

• Advantage is the ability to create an environment

that facilitates deliberate practice (Weller et al. 2012)

Purpose

5

• To create a simulation-based medical education

tool

• To test Epworth’s HDR emergency procedures

• To meet AAPM TG 59 recommendation of

containment in 1-2 minutes

• To provide training, feedback and credentialing of

brachytherapy staff

Methods

6

• HDR Emergency Procedures

• High fidelity simulation to accurately represent the

clinical environment

• Hybrid simulation approach

• Used a Laerdal SimMan Essential Patient

Simulator TM female pelvis mould

• HDR emergency was simulated

(Laerdal helping save lives 2001)

Methods

7

• Simulation was recorded on 5 cameras

Results

8

• Simulation 1

• Videos\Onc Scenario 1.m4v

• Simulation 4

• Videos\Onc Scenario 4.m4v

Results

9

Simulation Role Individual

Time (sec)

Time Source

Contained (sec)

Total Time

(sec)

Simulation 1 Physicist 21 44 126

RO 87

Nurse 63

Simulation 2 Physicist 22 40 108

RO 68

Nurse 50

Simulation 3 Physicist 21 40 105

RO 59

Nurse 42

Simulation 4 Physicist 20 40 104

RO 67

Nurse 51

Discussion

10

• Debriefed after each simulation

• Identified gaps and processes were put in place to

improve emergency procedures

• Staff movement throughout the emergency

situation needed improvement

• Highlighted the importance of staff-patient and

staff-staff communication

Conclusion

11

• Successfully tested and reviewed Epworth’s

emergency procedures

• Simulation based training has given Epworth

Radiation Oncology a valuable training tool

• Source was removed and contained in less than

45 seconds in each simulation

• Total emergency response time was improved by

18%

Acknowledgements

12

• Epworth Radiation Oncology

• Epworth Simulation and Clinical Training team –

Tom Hallahan, Daniel Knoche & Tess Vawser

References

13

• Kubo, H. D, Glasgow, G. P, Pethel, T. D, Thomadsen, B. R, &

Williamson, J. F 1998, ‘High dose-rate brachytherapy treatment

delivery: Report of the AAPM Radiation Therapy Committee Task

Group No. 59’,Medical Physics, vol. 25, no. 4, pp. 375-403.

• Laerdal helping save lives, 2001. Available from:

˂http://www.laerdal.com/au/˃ [11 February 2014].

• Weller, J. M, Nestal, D, Marshall, S. D, Brooks, P. M, & Conn, J. J

2012, ‘Simulation in clinical teaching and learning’, The Medical

Journal of Australian, vol. 196, no. 9, pp. 594-598.

• Ziv, A, Wolpe, P. R, Small, S. D & Glick, S 2003, ‘Simulation-Based

Medical Education: An Ethical Imperative’, Academic Medicine, vol.

78, no. 8, pp. 783-788