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Tracheostomy Training Overlay System for Standardized Patients

This story was originally posted by HealthySimulation on December 26th, 2018.

The Tracheostomy Overlay System (Avtrach) is a wearable chest plate for standardized patients (SPs) that can be used in skills and simulation education. The current use of SPs in healthcare simulation is proven to be an effective way to increase fidelity; however, there are many limitations on the type of injury or illness that can be assigned to SP cases. When using SPs, complex cases that require invasive lines and tubes, such as a tracheostomy tube, are not currently feasible, and although high-fidelity (HF) manikins have this capability, they lack the necessary human interaction and feedback that SPs offer to clinical simulation. 

The Avtrach has been developed and evaluated by an interdisciplinary team of faculty and students from three departments (engineering, nursing, and theatre) to address the limitations of the SPs in simulation. 

The device sits over the actor's torso, aesthetically representing a chest and throat with an inserted tracheostomy tube. Nursing students can now perform tracheostomy care and suctioning on a live patient and perform an assessment, tracheostomy care, and suctioning while the actor reacts appropriately to deep suctioning or too much faceplate pressure/manipulation using cues built into the device. Additionally, this device can be used for scenario-based nursing simulations that are designed for patients with a tracheostomy.

The Avtrach is a vest that provides the appearance of a lifelike male torso, worn anteriorly on a live actor. The vest contains an integrated sensor system to detect improper tracheostomy care and/or suctioning technique by a trainee. 

To evaluate the effectiveness of the Avtrach as a clinical training tool, junior-level nursing students (trainees) were invited to participate in a prospective, randomized control trial approved by the Institutional Review Board of University of Delaware (University of Delaware, Newark, DE). Trainees were recruited from an adult health medical surgical course at the University of Delaware. None of the nursing students had prior instructional or clinical practice providing tracheostomy care or suctioning. Trainees were randomly assigned to tracheostomy care and suctioning instructional modules involving either static manikin training (Manikin) or simulated patients wearing the Avtrach system.


These results strongly suggest that the Avtrach is an effective tool to improve technique, fidelity, communication, and preparedness for clinical practice. Observational data show that nursing students interact with the standardized patient much more readily when training with the Avtrach as opposed to the manikin. The participants were found to correct their own mistakes, ask questions, offer reassurance, and explain the procedure to their patient more often when training with the Avtrach. This indicates that when training with the Avtrach, nursing students demonstrate real-time recognition of error and are able to correct their technique, resulting in greater attention to patient safety.

The results of this study demonstrate that the Avtrach has the potential to substantially improve simulated nursing education in both academia and clinical practice settings in tracheotomy care and suctioning. This device offers simulation centers an educational tool that closely mimics clinical practice and provides educators with an opportunity to assess their students' ability to recognize and correct errors in patient care before they ever provide care in a clinical setting. The Avtrach system enhances the fidelity of tracheostomy care and suctioning while contributing to the development of therapeutic communication skills of the healthcare professional. Nursing students are able to recognize mistakes before they have built muscle memory, which would contribute to improved patient outcomes. This novel method of training is available for purchase on Avkin's website.

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