Simulation Lab Helps University Hospitals ED Teams Prepare for Any Emergency
February 23, 2025
UH Clinical Update | February 2025
When you work in Emergency Medicine, you’re never sure who you’re going to treat that day in the ED or what challenges you’ll face. But part of providing the highest-quality care to our patients means being prepared for anything – no matter how unusual.
“We need ways to train for those high-risk, low-volume procedures for when it's the middle of the night and you're the only person who's around who can do it,” says Vicki Noble, MD, Chair of Emergency Medicine at UH Cleveland Medical Center and Arthur D. and Kazuko Maine Endowed Chair in Emergency Medicine Leadership.
One solution for this at UH is the Emergency Medicine Sim Lab, led by physician Daniel Saadeh, MD, and coordinator William LaRue. Launched in late 2021 with a generous donation from Emergency Medicine physician Howard Dickey-White, MD, it includes a van, mannequins and other equipment for practicing at sites across the system. Teams of physicians, nurses and APPs run simulations together of specific emergency situations and “procedure refreshers” to refine their skills. They then “debrief” afterward to discuss how they could improve next time – and when the situation arises in real life. Some simulations occur at Main Campus, both for Emergency Medicine residents and attending physicians. Others take place on a regular basis at UH community hospitals, focused mainly on OB emergencies.
What makes a Sim Lab?
The most eye-catching part of the Sim Lab may be its high-fidelity mannequins. These help promote hands-on learning for “HALO” events, Dr. Saadeh says – meaning high-acuity, low-occurrence. For example, to prepare Emergency Medicine teams for the unusual event of a woman late in pregnancy going into cardiac arrest, the Lab runs simulations with a “pregnant” mannequin that can even “give birth” – helpful in practicing resuscitative hysterotomy – a special C-section aimed at saving both mother and baby.
Emergency Medicine Sim Lab.“It's very low occurrence, but when it does happen, it's very intense,” LaRue says. “You've got to know what to do when to do it, otherwise, you may lose one or both patients. Those are the things that we focus on when we do these simulations.”
Another mannequin is outfitted with homemade simulated vomit. “I have my own recipe,” LaRue says. This is helpful, he says, in training teams how to successfully complete suction-assisted laryngoscopy and airway decontamination (SALAD) – a procedure developed to overcome the challenges of a massively contaminated airway.
But beyond the flashy mannequins, it’s the people and the learning that occurs that really fuel the Sim Lab in Emergency Medicine. Dr. Saadeh trained for exactly this – he did his emergency medicine residency training at UH Cleveland Medical Center, followed by fellowship training specifically in medical simulation at Indiana University School of Medicine. William “Sarge” LaRue has helped build the lab to where it’s now his full-time job, building on 34 years as a combat and flight medic in the U.S. Army and Air Force, where much of the training was done through simulation.
Practicing and Analysis Promotes Learning
Part of the power of the Sim Lab, Dr. Saadeh says, is drawing out the different learning needs of the team during the simulation -- but then addressing them in a supportive way during the debrief.
“We focus on something called psychological safety, which really encourages people to speak about things that they may feel less comfortable about,” he says. “The debrief is really where the education comes from. It’s designed in a way where it’s a very casual conversation. And we try to focus on what we call the individual's frame. For example, what I may observe and think during a case is different from what anyone else may think.”
In many cases, Dr. Saadeh adds, it’s not a lack of medical knowledge that leads to errors in emergencies, but workflow or communication issues. It could be, for example, that a team member’s voice was too soft for others to hear as they were managing the emergency.
”A lot of our debriefing is talking about communication team dynamics,” he says. “It’s very focused on figuring out what each person's perspective was, and then bringing that up to the group. And you learn from all your teammates.”
Growing Popularity
Statistics from Emergency Medicine show that UH caregivers endorse this approach to quality improvement and safety for our patients. While the Sim Lab started as a training tool for medical residents, it’s now expanded to attending physicians, advanced practice providers and nurses, with simulation classes increasing by 30% in 2024 and a 16% increase in attendance. “Sarge” LaRue says some UH caregivers at community hospitals even come in to work on their day off when they know the Sim Lab team is coming.
He and Dr. Saadeh see nothing but more growth for the Emergency Medicine Sim Lab – and they invite UH caregivers to learn more about learning opportunities available.