|L. Michael Fraai (left), director, biomedical engineering, Brigham and Women’s Hospital; and Jacinta Telesford-Ximba, bedside technology specialist.|
Moore’s Law suggests that the number of transistors that can be inexpensively placed on a chip doubles approximately every 2 years. Moore was Gordon Moore, the co-founder of Intel, and his prediction pointed toward greater performance, efficiency, and flexibility in related technologies.
The technology industry, business, and consumers have eagerly watched this progress. New applications can do more with greater ease, but more complex technologies are—well—more complex.
“Technology will only get more complex, and people will rely on it more and more,” says L. Michael Fraai, CCE, MS, director of biomedical engineering, Brigham and Women’s Hospital, Boston. “To understand how technology is used as a tool, you must understand the use model and how you can configure the technology to match the clinical care practice.”
Fraai defines this ability as a soft skill that complements a sound technical foundation. To build this skill as well as others, Fraai supports education, even suggesting that training is a new frontier. “It helps technical staff to gain a better understanding of the use model,” Fraai says.
But Fraai does not just support expanded knowledge of the clinical perspective by biomeds; he also supports health providers learning more about clinical and biomedical engineering. Subsequently, the Brigham and Women’s biomed department has implemented programs with other departments, particularly nursing, designed to expand education, inspire collaboration, and improve relations.
One innovation is the bedside technology specialist who acts as a direct liaison between the nursing and biomedical engineering departments and who helps translate each other’s words and actions. The new Nursing Simulation Center, officially opened in December, offers training scenarios for both nurses and biomeds. An intended benefit is better working relations. Presenting real-life situations with actual equipment, the center’s training sessions can help the staff of both departments become more comfortable with technology and potential patient challenges without actually putting patients at risk. In addition, by training together, nurses and biomeds learn how to work together. “We are building relationships with clinicians in the broadest sense,” Fraai says.
The simulation center provides an opportunity to collaborate in other areas such as purchasing. Clinicians can test new technologies in the facility’s lifelike rooms and provide feedback about usability. “We will work as a team to determine if there is a better way to deliver the same care and configuration,” Fraai says.
Liaison Links Biomeds and Nurses
One way to inspire the team approach is through understanding, which can be more difficult to achieve when the groups speak different languages. “If I better understand the technology, I can better speak the language with biomeds and have it be more collaborative, rather than asking them to rescue me from a piece of equipment that seems to be not working,” says Miriam Greenspan, RN, MS, program coordinator of the Center for Nursing Excellence at Brigham & Women’s.
“Nurses do speak a totally different language than biomeds,” says Jacinta Telesford-Ximba, RN, BSN, MA hrm, MBA, the current and sole bedside technology specialist at Brigham and Women’s. Created 3 years ago to find ways to work around these differences and to foster cooperation and communication, a large portion of the bedside technology specialist’s job is devoted to translation.
Michael Dumais, RN, BSN, MEd, now the hospital’s director of educational technologies, was the first bedside technology specialist at Brigham and Women’s. He concurs, saying, “This job is 99% collaboration and getting folks to understand each other’s languages.”
Along with translation, the bedside technology specialist focuses on education and regulations. One goal of the position is to determine how to increase the effectiveness of the biomedical devices and to increase patient safety. Another is use education. Both Dumais and Telesford-Ximba have held numerous in-services to train clinicians and biomeds on the use of equipment such as infusion therapy devices, defibrillators, and monitoring systems.
“An unexpected benefit [of the position] was that not only could I teach nurses how to use the equipment, but I could also teach the technicians—not from a nuts-and-bolts perspective but from a clinical perspective—which increased their understanding and simplified their troubleshooting,” Dumais says.
Dumais also found an unexpected role in the investigation of sentinel events. When one occurred involving a biomedical device, he would examine the data logs of that piece of equipment as well as interview the clinician and other participants to make sense of what happened and determine whether there was a need to report the incident to the FDA. Telesford-Ximba continues this practice.
According to Dumais, many biomedical and clinical engineering departments return the device to the manufacturer to interpret the data logs, and then hope the interpretation is good. “We are unique in that we analyze the incident logs ourselves along with critical thinking, the technician’s knowledge, and the bedside technology specialist’s clinical skills to paint a picture of what happened. We can put together a good clinical story for each sentinel event,” he says.
Taking control of this process results in action. “We are able to do good work if we really understand where the problems and issues existed with a sentinel event. We can draw good conclusions and prevent it from happening again in the future,” Dumais says.
Of course, part of this effort takes place through training. “Even though we are not a training department, we do provide training on new equipment as well as any new or enhanced features,” Telesford-Ximba says. “We make sure the nurse educators, nurses, clinical engineers, and technicians know how to use the devices.” Simulated events build in reality without endangering patients and are the cornerstone of the new Nursing Simulation Center.
The team credits Fraai with being the visionary for the center, a sentiment Greenspan echoes, describing its history, which has its roots in the biomedical department. The inspiration came from the large number of troubleshooting calls the biomed department would receive after a new system went live.
“Immediately following a go-live, we’d be inundated with telephone calls saying the system was not working properly,” Dumais says. “When we compared the calls to the in-service education records, we observed that those people who did not get the training were always the ones who called.” Concerned about costs and patient safety, Fraai wanted a solution that involved training in a nonthreatening environment and settled upon simulation as the best way to go.
“Driving the need for training from both a clinical and technical perspective is the fast change in technology and the fact that it is a tool clinicians are relying on more and more,” Fraai says. “We wanted to create an environment where people could be trained on it outside of the operational pressures.”
Collaboration with nursing began almost immediately. Diane Campbell, BSN, RN, and Carol Luppi, BSN, RN, applied for and received a grant through the Mary Fay Enrichment Award to travel to Oregon Health and Science University in Portland to study its simulation center. They brought the information back to Fraai, and the two groups developed the center together.
The facility features two ICU beds that also can function as step-down and one neonatal unit. Each setup includes the equipment that would actually be used within the hospital. A high-fidelity mannequin—that the team has named Sadie—acts as the patient, providing realistic anatomy and clinical functionality.
Learning to Get Along
Collaboration, communication, investigation—these are all words used to describe the bedside technology specialist position at Brigham and Women’s Hospital in Boston, which was created to liaise between biomedical engineering and nursing, and therefore foster greater collaboration. They come from Michael Dumais, RN, BSN, MEd, currently the hospital’s director of educational technologies. He was the first nurse to hold the position and the first nurse to hold any position in the institution’s biomedical engineering department. The words and the idea are great in theory, but how do they translate to every day?
Jacinta Telesford-Ximba, RN, BSN, MA hrm, MBA, the current bedside technology specialist at Brigham and Women’s, describes a typical day as one centered around customer service and involves communication, interaction, collaboration, and investigation. “If there are problems with equipment or questions about the devices, or even a need for clarification of the use of a device, I get involved,” Telesford-Ximba says. “I do a lot of intervention, communication, collaboration, and follow-up.”
For example, in a common scenario involving a malfunctioning piece of equipment, the nurse calls the biomed department for repair; the biomed who takes the call begins to troubleshoot over the phone, asking questions about the problem and the device’s status. “The biomed wants to gather as much information as possible so they can come to the floor ready to fix the problem, but the nurse is frustrated by the questions because they just want someone to fix the problem,” Telesford-Ximba says. “By the time the nurse calls for help, she has typically tried everything possible and is exasperated.”
In this instance, Telesford-Ximba recommends the biomed go to the floor to troubleshoot. “The biomed can ask the same questions, but the nurse will be calmer because someone is there,” she says.
Another situation where miscommunication can occur is in the patient room during repair. Telesford-Ximba suggests that a nurse who lingers while a biomed completes a repair is not keeping a watchful eye but rather a curious eye. “If the nurse doesn’t leave the bedside, it’s not that she or he doesn’t trust the biomed, but wants to see what he or she is doing. It’s a way of saying she or he is interested and wants to learn,” Telesford-Ximba says. So Telesford-Ximba will suggest the nurses ask the biomed to show them when they want to learn.
“It’s making sure both sides don’t make assumptions about each other because they are both trying to do the same thing,” Telesford-Ximba says. “Everyone wants to do a good job, and the reason they get frustrated is because they care.”
The training program is still in development but features lifelike scenarios that grow in patient and technology complexity. “We try to build a lot of reality into the scenarios and have based them on calls we have actually received,” Telesford-Ximba says. Currently, experienced nurses new to Brigham and Women’s are being trained in the center as part of their orientation. About three groups have completed the initial 2-day program featuring five scenarios.
“Each simulation scenario is self-contained. Afterward, everyone leaves the lab for a debriefing,” Greenspan says. The discussion, which may involve video recordings, reveals processes and areas for improvement. The idea is not to focus solely on technology but also on patient care techniques and collaboration.
While the center is primarily intended for nurses, biomeds get training time, too. Currently, 1 day of the week is dedicated to biomedical education (although the program is still in development), but joint training scenarios also have been created. “We can simulate failures on equipment as well as evaluate technology and perform validation and configuration studies,” Fraai says.
The environment is meant to be stress-free, and the ability to test new equipment in the nonthreatening environment is a big bonus. “The simulation environment is safe, nonjudgmental, and lifelike,” Greenspan says. “We can see how people interface with the technology and look at things like buttonology. We can get their feedback on ease of use and workability.”
Feedback has supported the realism, and nurses who have been through the simulation program report less stress their first day on the unit.
“It’s a much more relaxed environment for training and improves the quality of work life because people are not trained on live systems,” Fraai says. The collaborative effort permits nursing and biomedical engineering to form relationships from the start while they train together. “They become part of an integrated team up front,” Fraai says.
Making It a Reality
The center has brought about another benefit—the greater ability to recruit and retain talent. This was one reason the team was able to get administrative support. “We really had to format the goals to get executive buy-in,” Fraai says. The collaboration with nursing achieved their buy-in as well.
The team was clever in gathering resources. “Over time, we made our purchases piecemeal,” Fraai says. If a project came in under budget, the extra funds, if available, were tactfully redirected toward the simulation center (with appropriate approvals, of course). Fraai estimates the overall investment was about $200,000. “Most of the equipment was negotiated with vendors, but we did spend a lot of money on the video system,” he says.
Space represented the biggest challenge. “I don’t know of any hospital that isn’t clamoring for more space, especially nonclinical space,” Greenspan says. Nursing had an education facility, but it was not big enough to hold the envisioned center. Careful negotiations led to more adjacent space, and the simulation facility had a home. Located in a mixed-use building, the center shares space with administrative offices for the hospital. Contractors and regulators had to be convinced of the value to get approvals for the utilities and equipment, including items such as oxygen and compressed air.
“There were components of the institution that were skeptical, so maintaining consistent executive support was a challenge, but we just maintained communications and kept on explaining the benefits,” Fraai says.
Simulated Scenarios, Real Relationships
The benefits have been numerous, but the biggest bonus has been the collaboration. Enhanced relationships, according to Greenspan, include those between nursing and biomedical engineering, pharmacy, materials management, and IS. “Many departments that we contacted and collaborated with to create this very realistic patient care environment have all been very responsive and terrific in working with us and teaching us as we go along,” Greenspan says. “As we move along, we are hoping to take that kind of relationship to the bedside. This is particularly true of the relationship nursing has with biomedical engineering.
“We’ve had a great collegial relationship with biomed,” Greenspan says. “The realism of the lab would not have been possible without them. Every time they come in, they think of another way to make it more realistic. We want to bring that method of interaction to the units.”
Biomedical engineering already pushes to work more closely with customers. For example, the department runs new ideas by clients, such as the nursing department, to ensure the ideas are in alignment with the client’s mission and vision. “We don’t want to be too far to the right or left, and we communicate and get a lot of feedback,” Fraai says.
That feedback is key to whether or not the department will pursue the idea, but the fact that the feedback is even gathered encourages innovation. “If someone has an idea, it doesn’t immediately get shot down but is explored,” Telesford-Ximba says. Just the fact that the bedside technology specialist position exists points to the willingness of the biomed department and the institution to explore new ideas. “The concept of having a nurse in the biomed department was unprecedented, with the exception of Massachusetts General Hospital [Boston], when the position was first created,” Dumais says.
The resulting day-to-day collaboration has made a difference in the department and the institution’s function. “Technology is moving at such a fast pace,” Fraai says. “We need to make sure we collaborate properly with clinicians so that we understand the clinical care practice, how technology can be used as a tool in that process, and all the challenges that come with it.” Liaisons and training are two steps that Brigham and Women’s has taken to achieve this goal. Gordon Moore would be proud.
Renee Diiulio is a contributing writer for 24×7. For more information, contact .