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Waikato Hospital Simulation Training Keeps Hearts Pumping
A world-class simulation training programme developed at Waikato DHB to help a specialist cardiac unit prepare for the unexpected is drawing attention across the country and overseas.
The training sessions for the Cardiac Catheterisation Laboratory, more commonly known as the Cath Lab, is the brainchild of Waikato Hospital interventional cardiologist Dr Madhav Menon who worked alongside with colleagues from the UK, USA and Australia.
The Cath Lab focuses on diseases of the heart, arteries, valves and rhythm. They are minimally invasive procedures like coronary stents to open blocked arteries, transcatheter valve implants, pacemakers, mapping of electrical pathways and ablations. Patients are cared for by a team of dedicated multidisciplinary staff.
Dr Menon says procedures being done in the Cath Lab have become more complex with the ability to deliver a wider range of procedures to patients as technology and skills improve.
"Most of the time things go like clockwork, but in the rare event that a patient has an adverse reaction, the situation can turn for the worse very quickly. Unless a team is highly trained, skilled and able to manage the situation in a clear and methodical manner the outcome can be poor."
He says the need to continuously upskill and maintain the ability for the whole team to manage crisis situations in the Cath Lab is clear, comparing it to the discipline in the aviation sector.
"The airline industry is very strict about these protocols and they repeatedly train on simulations to deal with emergencies.
"In any situation where people aren’t prepared and something goes wrong, usually everyone jumps in with the best intent to try and help out. In the process this leads to chaos and confusion mainly due to disconnected communication. We don't want that. We need an orchestrated symphony and for this we need to simulate emergency situations to train to respond to the moment," Dr Menon says
The development of the New Zealand programme began after two training days were held at Waikato Hospital in 2019. The framework used, called REACT, was originally from the UK, but was modified to meet with New Zealand requirements.
Dr Menon and senior registered nurse Maree Smith set out to adapt the methods to a New Zealand context with the help of experts from across Waikato Hospital including senior doctors, Cath Lab nurses, medical radiation technologists, physiologists and with support from Rob Sinclair and Deb Cox from the DHB’s Clinical Skills and Simulation Centre as well as the hospital's audio-visual department.
Conducting a REACT simulation day involves extensive multidisciplinary input and support.
Maree says the goodwill and collegiality displayed within the REACT NZ faculty is fantastic.
“We couldn’t run such a high quality training day without this multi team support", she says
REACT training is conducted in the Cath Lab involving a state-of-the-art mannequin which is fully controllable - everything from breathing to blinking – along with the equipment normally used in a Cath Lab.
Situations are tailored to suit a variety of training needs, including cardiac arrest, stroke, vessel rupture, an angioplasty where a wire can sometimes perforate the coronary artery or a tamponade where bleeding around the heart causing the pressure to drop and the patient to become compromised.
The simulation is fed back via audio/visual link to a second training group to observe and discuss what's happening before switching with the other team in the Cath Lab who go on to have a full debrief.
Dr Menon says regardless of the scenario, it's important the problem can be recognised in a timely manner and dealt with.
"Time is crucial and if you don't make a call, nothing happens and the patient can deteriorate quickly."
Maree says the training has so far paid off, with emergency situations in the Cath Lab being dealt with in an orderly and structured way.
"Staff not involved in the situation say they've been completely unaware of a serious issue unfolding, when a trained REACT team is managing a complex, high stress situation effectively and calmly.
"Our desire to ensure that cardiac patients receive the best possible care during the worst possible times is a huge driver for us," she says.
REACT NZ conducted two courses at the Waikato Hospital Cath Lab last year and has six courses planned throughout 2021.
There has already been strong interest from across the country and even Australia, with the latest course held over the weekend involving staff from other DHBs.
REACT NZ will become part of the standard Cath Lab quality control training at Waikato Hospital, with the overall aim for it to be rolled out across the country.
A video of the Cath Lab simulation training is available here.
Waikato District Health Board
Healthy People. Excellent Care
Waikato District Health Board (DHB) employs over 6500 people and plans, funds and provides hospital and health services to more than 391,770 people in a region covering eight per cent of New Zealand.
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