To err is human: use of simulation to enhance training and patient safety in anaesthesia (original) (raw)
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Improving Patient Safety through Simulation Training in Anesthesiology: Where Are We?
Anesthesiology Research and Practice, 2016
There have been colossal technological advances in the use of simulation in anesthesiology in the past 2 decades. Over the years, the use of simulation has gone from low fidelity to high fidelity models that mimic human responses in a startlingly realistic manner, extremely life-like mannequin that breathes, generates E.K.G, and has pulses, heart sounds, and an airway that can be programmed for different degrees of obstruction. Simulation in anesthesiology is no longer a research fascination but an integral part of resident education and one of ACGME requirements for resident graduation. Simulation training has been objectively shown to increase the skill-set of anesthesiologists. Anesthesiology is leading the movement in patient safety. It is rational to assume a relationship between simulation training and patient safety. Nevertheless there has not been a demonstrable improvement in patient outcomes with simulation training. Larger prospective studies that evaluate the improvement...
Simulation and patient safety: The use of simulation to enhance patient safety on a systems level
Current Anaesthesia & Critical Care, 2005
Errors in healthcare feature in the 10 leading causes of death. The identification of the sources of such errors and the development of countermeasures whether against errors made by individuals or errors occurring due to latent conditions at system level are the key strategies in tackling this large problem. Simulation-based teaching can make meaningful contributions to this process in many ways and at many levels. At the level of the individual healthcare professional simulated clinical scenarios can raise awareness of the nature of the problem and demonstrate the relevance and need for training in a crew resource management type of course. At the level of an anaesthetic department such courses can help provide a common approach to problems in an area neglected by traditional teaching and so improve communication in this area. The use of simulation also extends to research and development. Study of the use of key resources, such as personnel or equipment, under stressful conditions in a simulated environment can help not only detect possible sources of error but can also help develop strategies to provide effective specific countermeasures.
Simulation: A Training Resource for Quality Care and Improving Patient Safety
Nursing - New Perspectives [Working Title]
Patient safety is an ever-present topic in the discussion of educators. It has been 20 years since the publication of To Err Is Human, and there are lessons learned, although there is still much to be done. Healthcare systems are becoming increasingly complex, putting the safety of patients at risk. In this context, there is a greater exposure of healthcare professionals to medical-legal liability issues and to becoming victims of situations that are often preventable. Nurses and medical doctors are especially exposed to these situations, since they are visible during procedures, or do so during the points of greater risk during the patient care process. This chapter will review the contribution provided by the curricular integration of simulation-based education as a tool to train technical and nontechnical issues and how this work can be done for the safety of patients through a standardized training plan, under controlled and evaluated processes. We will discuss how resources and elements allow to perform healthcare interventions in a more safely manner. Finally, we will review the existing literature, some experiences, and the available evidence on this topic.
Using Simulation-Based Training to Improve Patient Safety: What Does It Take?
The Joint Commission Journal on Quality and Patient Safety, 2005
S imulations have been used as early as 1910 as a means to train both persons and teams to reduce errors and improve safety. 1 Commercial aviation and the military have invested heavily in the use of simulation-based training because it offers a realistic, safe, cost-effective, and flexible environment in which to learn the requisite competencies for the job. 2,3 Given its purported success in these areas, the use and application of simulations as a training tool has spread to a number of other domains, such as business, education, and medicine. 4 The focus of this article is on providing researchbased guidelines extracted from the military and commercial aviation communities' experiences in designing and delivering simulation-based training for application in the health care community. Although the popularity of simulation-based training has grown during the past decade, using simulation as a part of training is not a panacea. Our review of the team training literature in health care, which we conducted in 2004, 5 showed, for example, that simulation-based training is used to improve team performance (for example, anesthesia crisis resource management training 6). However, it appeared that simulation-based training programs early on either focused on the engineering component of training (that is, the simulator itself) or took a more balanced approach in which simulation is studied in the context of a learning methodology. 5 For example, in a study conducted by Howard and colleagues, 6 the training program focused more on how trainees use the simulator rather than on how the team should work together to respond to the situation.
Journal of Veterinary Medical Education, 2018
A veterinary anesthesia simulated environment (VASE) with clinical scenarios has been integrated into the pre-clinical curriculum at Midwestern University College of Veterinary Medicine to simulate anesthesia of a live patient within a surgical suite. Although this modality was shown to significantly improve veterinary students' perceived preparedness to perform anesthesia on live patients, whether this would improve anesthesia competency in the actual clinical environment, described as operational performance, remained unclear. Our goal was to examine the relationship between anesthesia simulation training and student anesthesia operational performance. Anesthesia operational performance assessment of students was determined by quantifying critical event occurrences that negatively impacted patient safety during the anesthesia of 287 patients during students' initial surgical experience in 2015 and 2016. The relationship between total numbers of critical incidents to students having anesthesia simulation training was determined through evaluation of anesthesia records from 2015 and 2016, where students did not have anesthesia simulation training or they had pre-clinical training, respectively. Results showed a significant relationship between simulation training and critical incident occurrence, with a critical incident more likely to occur during patient anesthesia for students who did not experience pre-clinical anesthesia simulation training. Of the total critical incidents that occurred in the two-year study, 88% were in patients anesthetized by students who did not have simulation training. Our findings suggest that students who were given the opportunity to participate in anesthesia-focused simulations before a live-animal anesthesia encounter demonstrated significant improvements in anesthesia operational performance and improved patient safety.
Inefficacy of simulator-based training on anaesthesiologists' non-technical skills
Acta Anaesthesiologica Scandinavica, 2009
Background: Analysis of critical incidents in anaesthesia practice emphasizes the important role of non-technical skills (NTS) in improving patient safety. Therefore, debriefing with regard to NTS has been added to medical management (MM) simulator training to improve acute crisis competencies of anaesthesiologists. The purpose of this study was to compare the NTS and MM performance of two groups of anaesthesiologists in a simulated anaesthesia crisis after undergoing different types of training. Methods: Forty-two anaesthesiologists were randomly assigned to two different training groups, with each group participating in two simulation training sessions. One group's (NTS1MMG) training included extensive debriefing of NTS (resource management, planning, leadership and communication) and MM, while the other group (MMG) received a simpler debriefing that focused solely on MM. The quality and quantity of NTS and quality of MM performance were rated by reviewing the videotapes of the scenarios. Results: NTS1MMG did not prove superior to MMG with regard to behavioural and MM markers. The quality of NTS performances correlated significantly (Po0.01) with the quantity of NTS demonstration, and also correlated significantly with the MM actions (Po0.01) in both groups. Conclusion: A single session of training including debriefing of NTS and MM did not improve the NTS performances of anaesthesiologists when compared with anaesthesiologists who only received MM training. This might indicate that a more frequent or individual training is needed to improve participants' NTS performance.
Chapter 45 . Simulator-Based Training and Patient Safety
2001
For a number of years, simulators have been used in aviation, nuclear power, military flight operations and other industries as a training tool and method to assess performance. Their use is nearly universal in high reliability organizations. Recently the use of simulation in medicine has increased markedly, in part due to greater awareness of the importance of patient safety. Defined broadly, a simulator replicates a task environment with sufficient realism to serve a desired purpose. In medical training, simulators can substitute for actual patients and can be as simple as utilizing pigs’ feet to practice suturing, or as complex as virtual reality machines and re-creations of actual clinical environments for surgeons, radiologists and anesthesiologists. In a general sense, they improve patient safety by allowing physicians to become better trained without putting patients at risk. For example, in a randomized controlled trial, Peugnet and colleagues used a virtual reality simulato...
2005
The Effective Management of Anaesthetic Crises (EMAC) course was developed in response to several factors. The increased incorporation of workplacebased assessment into the whole assessment process revealed difficulties when trying to deal with important areas such as the management of anaesthetic crises. At the same time the development of simulation centres combined with an increased interest and understanding of the role of human factors in anaesthesia offered a potential solution. A partnership between the Australia and New Zealand College of Anaesthetists (ANZCA) and the Australasian simulation centres through a working party and a workshop created a blueprint for a course. Five main topics were identified-human factors, cardiovascular emergencies, airway emergencies, anaesthetic emergencies and trauma. A two and a half day course was developed using simulation, skills stations, presentations, demonstrations and feedback-led discussion as the major teaching methods. The main aim of the course was to teach not only what to do but importantly how to do it. The course was piloted and extensive evaluation yielded positive findings with the result that it was accepted by ANZCA for both trainee and career grade anaesthetists. Further evaluations are in place and will result in a revision of the course.
Simulation-Based Training in Anesthesia Crisis Resource Management (ACRM): A Decade of Experience
Simulation & Gaming, 2001
Several gaps exist in the training of clinicians in health care domains, such as anesthesiology, that have the cognitive profile of complexity and dynamism. These features are shared with other industries such as commercial aviation. Training for cockpit crews on Crew Resource Management (CRM) emphasizes decision-making and teamwork principles. The authors created a simulation-based curriculum (ACRM) for anesthesiology based on principles of CRM in aviation. The training philosophy adapted to health care is one of training single-discipline crews to work in teams. The ACRM curriculum involves highly realistic simulation scenarios requiring complex decision making and interaction with multiple personnel. Scenarios are each followed by a detailed debriefing using videotapes of the simulation session. ACRM has been adopted at major health care institutions around the world. Special training for instructors is provided, especially concerning debriefing. The ACRM approach has been extended to a wide variety of other health care domains that involve complexity and dynamism, such as emergency and trauma medicine, intensive care, and cardiac arrest response teams. Simulation-based training based on CRM principles is expected to become routine in many health care settings in the coming decade.