Children's Hospitals Today - Spring 2023 - 21

SIMULATION / FEATURE
AUGMENTED REALITY
Making life-saving simulations accessible
In rural Maine, difficult births led to
some long-term health disparities
when compared to their urban counterparts,
according to one study. In
hospitals with fewer than 500 delivieries
per year, as opposed to those with
more than 1,000, babies born needing
resuscitation had a higher incidence of
resulting brain injury. " It doesn't seem
fair that babies born in rural Maine
are more likely to have a poor neurological
outcome if they need resuscitation, "
says Michael Ferguson, M.D.,
pediatric intensivist at Barbara Bush
Children's Hospital at Maine Medical
Center in Portland.
When babies are born, about 1% to 2%
need intensive resuscitation. This is a
more frequent occurance for hospitals
that deliver 1,000 babies or more in a
year. However, many hospitals deliver
far fewer babies and only need to use
intensive resuscitation every three to
four years. " We know that if you don't
practice something every three months,
you lose skills very quickly, " says
Ferguson. " So, the simple answer
is to have providers practice
these skills regularly
with simulation. "
However, simulation
labs can cost a quarter of
a million dollars or more
to operate. " Where does
a rural hospital come up
with those funds? " says
Ferguson. " They just don't.
They don't do simulations because
they can't. "
After brainstorming how to bridge
BENEFITS OF
AUGMENTED REALITY
Using AR for
simulations improves:
* Access for clinicians
* Frequency of practice
* Realism of the activity
and patient
mannequin and a tablet-a " simulation
lab in a suitcase, " as Ferguson calls it. An
AR simulation blends the real-world environment-by
practicing techniques
on the mannequin-with visual and
digital elements in the virtual reality
headset, such as a baby's coloration or
other presenting factors.
With this gear, providers from anywhere
can practice intensive
resuscitation regularly. The
simulation center at
Barbara Bush Children's
Hospital serves as the
central hub, and participants
can access their
AR simulations remotely.
Beyond accessibility, AR
makes some aspects of
the simulation more realistic
than mannequins, like a
this gap in access and care, Ferguson
and his
team landed on augmented
reality (AR) simulation as an affordable,
portable solution. The simulation
acts out a real-time neonatal distress
scenario using an AR headset, a basic
baby's coloring, breathing habits and
movements. It also removes logistical
barriers such as space requirements
and reset and cleanup after a simulation,
allowing more people to practice
more frequently.
Currently, the simulation includes
practice on a premature and full-term
baby, but Ferguson hopes to expand
the program to include resuscitation
on a full-term baby, small child
and teenager.
The project started before the pandemic
with philanthropic donations
and grants from the Innovation Center
at Maine Health. As the program developed,
it was tested by providers
across Maine Health. Programmers
and learners alike had to learn how
to adapt to the headsets and lessons.
With topics like intubation, they had
to learn to blend and manipulate the
holographic part-what they're seeing
in the headset-with the physical
component, which is what they're
practicing on the mannequin. " There's
a learning curve at
says Ferguson.
first for people, "
" What you're seeing in
the glasses isn't really there, so we have
to sort of tease it out a little. "
The first set of simulation cases
started to roll out to hospitals in late
winter of 2022. " We know this does
not replace high-fidelity simulation, "
says Ferguson. " But we're trying to give
these hospitals an almost equal experience
and education. "
CHILDREN'S HOSPITALS TODAY Spring 2023
21
Children's Hospitals Today - Spring 2023

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