Revolutionizing Medical Education Technology with Texas Children's Hospital®
Healthcare professionals on the frontlines need adequate and up-to-date medical education technology to become more familiar—and confident—with performing procedures like IV insertion. Realistic training models can help healthcare staff provide better care to patients and may even save lives.
However, creating effective training models can be a challenge. Not only does this task require an expert engineering team, but it also relies on collaboration and feedback from medical professionals who use these tools every day. If you’re considering designing a new medical training model, consider the case study of RediStik, a line of wearable task trainers designed by Texas Children’s Hospital ® pediatric nurse practitioner Michael Pickett in collaboration with Pacific Research Labs’ Sawbones. In this case study, you’ll learn how Pickett developed new medical education technology from scratch with help from an experienced contract manufacturer.
RediStik: A Case Study
As an experienced nurse practitioner at Texas Children’s Hospital ®, Michael Pickett has used a number of training models and found some to be more useful than others. So, he decided to get involved with the hospital’s Innovative Solutions Council, a department tasked with assessing the hospital’s needs and coming up with new medical education technology in response. With the Council’s encouragement, Pickett enlisted the help of Sawbones to create an innovative and cost-effective line of RediStik task trainer products.
Michael Pickett came up with the idea for RediStik after noticing that hospital staff were unsatisfied with the standard IV trainers that were on the market. Healthcare professionals complained that many of the trainers weren’t realistic.
They were far too hard, making it difficult to stick needles in properly.
They were made of materials that couldn’t be cleaned with chemicals or dressed, as it would leave a chemical residue behind or damage the surface.
They weren’t wearable, so they couldn’t easily be placed in a natural position as a normal patient would.
They took too long to set up, so training sessions would usually last all day and practitioners couldn’t practice on them very often outside of these scheduled sessions.
The lack of realism in these IV, CVC and Port trainers was a serious problem because practitioners needed a high degree of realism to learn how to safely perform procedures that come with some level of risk. For example, not learning how to clean or dress the area properly before inserting a line can lead to a fatal bloodstream infection and sepsis. Likewise, ports in the chest and veins in the arm can be difficult to locate and insert a line into properly, so medical professionals need accurate training models to practice the procedure. The position of the patient’s torso or arm is also crucial in some cases, particularly for central line ports and ECMO cannulation.
Another problem was cost. Staff wanted task trainers that they could use multiple times or even practice on right before seeing patients to gain confidence and sharpen their skills. Trainers that were too fragile or costly weren’t an option.
To solve these problems, Pickett partnered with Sawbones to design the best quality, most realistic trainers on the market at a reasonable price. The goal was to make these trainers portable, easy to set up, engaging to work with, and supportive of “just in time” training”—he wanted practitioners to be able to set up and practice on the devices in just five minutes.
To meet these goals, Pickett and Sawbones took the following steps:
Getting the materials right: The trainers needed to look and feel like real tissue. The material couldn’t be too stiff for needles to be inserted. There also needed to be zero drag when the needle was pulled out. It took 12 iterations to identify the perfect materials for the tissue. The final iteration featured realistic self-sealing textured skin on the exterior and subcutaneous tissue beneath so practitioners could feel or see where the veins and ports were located. The veins even “rolled” like real veins do under skin. We discovered that vein illumination technology also works with our tissue and vessels.
Ensuring the material could be treated and dressed: Pickett and Sawbones tested that chlorhexidine (CHG) and alcohol could be safely applied to the material without leaving behind a residue. They found that the materials they chose could have a dressing left on without leaving behind any residue.
Making the trainers wearable: Pickett and Sawbones used a lightweight thermoplastic mold for the port and the PIV that could be put on a mannequin or on someone’s forearm comfortably. They also designed a needle proof backing to prevent accidental needle stick injuries.
Getting feedback and adding realistic details: Early testers for the peripheral intravenous line (PIV) trainers found the small vein to be difficult to find. To solve this problem, Pickett added another large vein in the design. This allowed practitioners to build confidence and skill on the larger vein that was easiest to find before practicing on the smaller vein. Pickett also designed a line of trainers for a range of skin tones, so practitioners would know how to identify veins on every patient.
Creating a portable kit: John James from Pacific Research Labs recommended that all of the training materials should be included in a single, portable bag. For example, one challenge early testers identified is that after inserting the needle, the synthetic blood tended to leak back out because the blood bag wasn’t positioned properly. To solve this, they included a tabletop phone mount in the bag that practitioners could attach the blood bag on to keep it elevated.
The complete port trainer kits include:
✓ Nylon carrying case
✓ Wearable trainer
✓ Lubricating jelly
✓ Talc powder
✓ Talc brush
✓ Color changing tablets
The PIV trainer kits include:
✓ Nylon carrying case
✓ Wearable trainer
✓ IV bag
✓ IV set
✓ IV clip holder
✓ 3 large and 3 small vein tubes
✓ Lubricating jelly
✓ Talc powder
✓ Talc brush
✓ Color changing tablets
The design, prototyping, and manufacturing process differed slightly for each of the trainers in the RediStik line. Generally, though, Pickett would come up with an idea and plan for a trainer, develop early prototypes and obtain end user feedback, Sawbones would engineer it, then Texas Children’s Hospital ® would test it, make modifications, and eventually use them for routine training. They also created videos showcasing how each trainer worked.
After countless iterations, modifications, and in-depth discussions with Texas Children’s Hospital ®, a line of wearable task trainers were created:
The PIV trainer kit that can withstand 1,000 or more punctures.
The port trainer kit that can withstand 1,200 or more punctures.
The CVC trainer kit. Tissue can withstand repeated skin preparation and dressing applications. Sterile blood collection and flushing via double lumen CVC.
The ECMO cannulation trainer kit that is currently undergoing a pilot program at Texas Children’s Hospital ®.
So far, results from the PIV and port trainers have been incredibly positive. After surveying 14 different clinical areas of the hospital, 100% of those surveyed said they would recommend the trainers to colleagues.
This medical education technology has also had a meaningful impact on patients’ lives around the world. For example, RediStik trainers were sent to clinics in Africa to train medical professionals on administering chemotherapy via IV. Due to lack of training, these IVs would often leak, causing wounds called extravasation. After just one year of training with the RediStik PIV kits, extravasation incidents decreased from 45% to just 5%. Prior to using the RediStik PIV Trainer, only 19% of PIVs were obtained with three or fewer attempts, post Task Trainer assessments reveal 99% of PIVs obtained with three or fewer attempts. It was a game-changer for these clinics.
As a case study in medical education technology, the RediStik line has been an indisputable success. Here’s what new product developers can learn from Michael Pickett and Sawbones’ process.
How to Develop New Medical Education Technology
Michael Pickett credits collaborative design for the success of the RediStik task trainers. He invited Sawbones into the design conversation early in the process. Initially, Pickett says he was interested in working with Sawbones because their costs were reasonable, and they were an employee-owned and engineering-focused company. What stood out to Pickett, however, was the fact that Sawbones understood his vision and the complex needs of medical professionals.
Creating new medical education technology isn’t easy. There are many design complications along the way, not to mention legal and professional standards that must be met. Innovation like this takes a great deal of time and effort. The design is only the first step of the process; the real work begins when you build that design into a working prototype. This requires a strong team effort. Pickett not only needed Sawbones engineers to help with the design and prototype iterations, but he also enlisted the help of his colleagues to test these products and ensure they met the highest expectations.
One tip that Pickett has for product developers looking to create new medical education technology is to get user feedback throughout the process. Building rough prototypes is fast and cost-effective when you work with a rapid prototyping expert like Pacific Research Labs. This allowed him to build multiple iterations of each trainer and immediately test them with help from seasoned experts in the field. Doing pilot studies and surveys also helps you evaluate safety issues and assess how realistic the product is. By the end of this process, you’ll be confident in sending your product out to the world.
The best way to start a project like this is to:
Work with an experienced contract manufacturer that specializes in collaborative iterative design processes.
Compartmentalize the project into manageable steps.
Assess the budget frequently. There were times during the development of RediStik that the budget was tight, but Sawbones worked with Texas Children’s Hospital ® to reduce costs.
Have a realistic timeframe in mind. There were some delays during the RediStik development process due to the complex and innovative nature of the design. Sawbones helped Texas Children’s Hospital ® stay on track and get the products to market as fast as possible.
The main reason why the Texas Children’s Hospital ® and Sawbones collaboration was so successful was because Sawbones really understood the hospital’s goals. They helped Pickett design medical education technology that was truly innovative and open source, meaning that anyone could access information on the trainers to use in their own clinics. The medical industry’s number one priority is patient care, and by working with a contract manufacturer that shared that value, Texas Children’s Hospital ® was able to make a meaningful and lasting impact on the world.
Working With a Medical Education Technology Expert