Cedars-Sinai Medical Center is a leading provider of quality medical care. Continuing medical education is provided to members of its medical staff, as well as physicians around the world who participate in their education process. In order to provide a more advanced and realistic environment for their educational process, Cedars envisioned and built a state of the art audio visual system for the newly constructed Women’s Guild Simulation Center for Advanced Clinical Skills. Cedars-Sinai medical center turned to Level 3 Healthcare to assist in developing a facility-wide solution.
Problem: Cedars-Sinai had a multi-room facility where each room hosted an independent audio-visual recording system. This approach prevented the simulation lab from creating multi-room, simulated scenarios where a team of doctors, nurses and support staff could receive a patient from the ambulance and follow them to the OR, ICU and eventually the doctor to the lobby for an update to the family.
Solution: The heart of the system is based upon a 128 x 128 video matrix switcher, over 30 pan-tilt-zoom HD IP cameras, more than 60 microphones, distributed speakers around the facility and a touch panel control system for ease of use. The customized control system allowed the Cedars team to create multi-room, multi-patient scenarios, select which cameras, microphones and patient information got ingested and recorded. This allowed the simulation specialist to follow the patient and the surgical team live, from room to room as the patient was transferred. Additionally, Level 3 Healthcare’s centralized audio visual architecture streamed the scenario live to debriefing rooms, conference rooms, auditoriums, doctors’ offices and to off-site observers. This enables the medical center to reach a much larger audience.
The design and integration Level 3 Healthcare implemented for Cedars would later that year win a “Best in Healthcare 2014” award for design and integration from Commercial Integrator Magazine.
Healthcare simulation’s primary goal is to design and facilitate scenarios to represent reality as much as possible. Level 3 Healthcare took three additional steps to enhance realism:
1. Integrated a wireless and discrete, in-ear communication system, placed on each of the standardized patients (actors portraying loved ones, doctors, anesthesiologists, etc.). Providing private communication to each or/all of the participants in the scenario. This ability to discreetly communicate with standardized patients enabled the simulation specialist, to initiate cues or verbal instructions during the scenario, while maintaining uninterrupted simulation session for learners. In essence, the scenario became a “mini live production studio” that improved realism.
2. The second enhancement was Level 3 Healthcare’s integrated voice synthesizing system. Each control station enabled the sim specialist to control a patient mannequin for advanced clinical encounters. Such scenarios often include vocal interaction between the patient simulator and doctor/nurse. The quality of the sim specialist’s vocal response is important, as it provides the cues a doctor or nurse needs in assessing the patient’s status. If the doctor/nurse is having difficulty understanding or hearing the patient it can lead to frustration, delay or miss-diagnosis. Often times the vocal reproduction hardware installed into mannequins does not provide clear and concise audio. Level 3 Healthcare’s voice synthesizing system provides a separate speaker for clear, concise audio as well as the ability to alter the voice to “fit” the patient. If the simulation calls for a pediatric assessment, a child mannequin is used and the voice synthesizing system alters the sim-specialist’s voice to match the child patient. Regardless of whether the sim-specialist is a male or female their voice will be converted to sound like a child. This produces a much higher level of realism during the simulation.
The integration of Level 3 Healthcare’s sim-specialist voice synthesizing system provides the operator a realistic and instantaneous means of speaking on behalf of the mannequin through the control station’s headphone or desktop microphone. Often, the operator’s gender and age may not match the scenario’s patient, so the voice synthesizing system instantaneously transforms the operator’s voice into any one of four (4) vocal presets: a) male to female; b) female to male; c) adult male to child; d) adult female to child. Level 3 Healthcare’s voice synthesizing system is programmable, requiring little to no adjustments.
3. Hospital sounds are also included to add further realism to the clinical environment. Such sounds might include emergency codes, or perhaps the sound of an arriving helicopter or ambulance. A digital annunciator server tied into the centralized speaker system did the trick. Hospital sounds can be easily initiated from any of the simulation control stations at the touch of a button and played overhead in any of the individual rooms, through a “follow the patient” scenario, or over the facility-wide speaker system. The simulation specialist can also page live over the system with personalized information: “Nurse Jones, please report to the nurses’ station.”
These added features have proven to greatly enhance the healthcare simulation community’s initiative of creating more realistic simulated scenarios.