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Many hospitals and medical schools offer some variation of simulation-based training in which medical and nursing students learn clinical techniques of suturing and administering medication by using lifelike mannequins. This strategy of helping clinicians develop skills on mannequins before treating actual patients is nothing new, but some hospitals are taking things to the next level by tying simulation to a newer concept: a culture of safety.
With the involvement of multiple levels of clinicians and nonclinicians in simulation centers designed with patient rooms, physician rooms, and nurses' stations, hospitals now use simulation training to improve patient safety through communication and teamwork.
Patient safety starts with teamwork
When the 450-bed Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, NH, renovated its second floor, hospital leaders made part of it into an 8,000-square-foot simulation center. The center is equipped with six patient rooms, an ICU, mannequins, and a nurses' station.
"It's a mini hospital," said George Blike, MD, quality and patient safety officer at DHMC and medical director at its Patient Safety Training Center. Having hospital leadership support the idea of investing in a simulation center is important to Blike. He said it can be tough to convince people that the answer is not always more production space, but rather more space to make production better.
"It's a place where people can learn how to learn," he said, emphasizing how quickly medicine changes. "The day you finish your training is the day you start becoming incompetent." He added that the center helps fight such complacency and keeps staff members entrenched in new methods and technologies.
"People learn technical skills here, but they are also learning peer communication," said Blike. "It's not just medical students and residents, but 7,000 staff who need and want to maintain their skills."
Patient safety begins with learning simple behaviors, such as how to brief and debrief, said Blike. He noted that a surgical safety checklist—something most hospitals use—is simply a way to ensure teams are briefing and debriefing. Simulation, he said, is all about enforcing these behaviors.
"That's a good habit to instill in people," Blike said. "That's what shifts culture ... they're learning how to have a [type of] behavior that is useful in every single patient encounter. Hopefully, it is unleashing and moving people over time toward being more reflective practitioners."
At the Tulane Center for Advanced Medical Simulation and Team Training in New Orleans, medical director James Korndorffer Jr., MD, FACS, is hoping Tulane's months-old center will benefit the medical students at Tulane University's School of Medicine, as well as staff members at the Tulane Medical Center. As with DHMC's simulation center, students and professionals use simulation training with a focus on teamwork. Using an incomplete team for simulation doesn't make good sense, said Korndorffer.
"When you're doing a coronary angiogram, for example, it's not just the cardiologist in there. It's the cardiologist, the radiation technicians, the nurses . . . everybody's involved," said Korndorffer. He notes that different simulation events also contribute to a culture of safety by providing a less stressful environment in which clinicians might be more likely to speak up when things aren't going right.
A good exercise for every hospital
The Agency for Healthcare Research and Quality (AHRQ) is currently funding research studies to determine how simulation training affects patient safety. Among them is a study run by David Gaba, MD, associate dean for immersive and simulation-based learning at Stanford (CA) University and director of the Patient Simulation Center of Innovation at VA Palo Alto Health Care System.
Gaba's team conducted a baseline safety culture assessment in three diverse hospitals: a large tertiary care academic hospital, a medium-sized suburban hospital, and a 25-bed rural critical access hospital. His team developed three 2.5-day simulation training programs, one for each hospital. The study is ongoing, but Gaba said the training is working.
"No matter how small a hospital is, it's possible for them to do very useful and beneficial simulation training," he said. "A lot of people think it's only for the big academic hospital, and really, that isn't true."
Like the other simulation centers, Gaba's focus is on behavior and teamwork as well as skills.
"In many courses we run, we shoot for about 40% on particular medical and technical issues . . . and 60% on generic behavioral principles of decision-making and teamwork, such as using all available information, cross-checking information, calling for help early, team management, leadership, communication, and distribution of workload," said Gaba.
To read more about simulation training, please see Briefings on Patient Safety, a publication of HCPro, Inc.
Tami Swartz is an associate editor at HCPro, Inc., where she serves as editor for books, videos, and other resources in the accreditation, quality/patient safety, and hospital safety markets. Tami also writes forBriefings on Patient Safety, an HCPro monthly publication. Contact Tami by e-mailingtswartz@hcpro.com.
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