The role of simulation in the reduction of medical errors
Tuesday, November 18, 2014
If you have taken a CPR class in the last few decades, you are familiar with Resusci Anne, the manikin used for learning CPR. The first Anne was invented to provide life-like training in the 1960s, and her soft helpless face was to inspire the rescuer to want to help the "dead" person.
Today, the use of simulation has evolved way beyond the initial revolutionary thoughts of the first creators of Anne. The use of simulations is now an integral part of most healthcare providers' curricula.
In 1999, the Institute of Medicine released their report "To Err is Human: Building a Safer Health System." Since then, the concept of patient safety and the prevention of error has been in the forefront of healthcare — especially in the training of new healthcare professionals. As healthcare delivery has become more complex and the public continues to rely on better outcomes, the use of simulation has been at the forefront of most education programs.
Simulation has moved beyond the simple manikin that does not respond, to sophisticated machines with which physicians and staff can interact as they assess and treat a changing patient condition. Ultimately, the goal is providing better patient care and reducing error.
The Society for the Simulation in Healthcare describes four main purposes for the use of simulation.
The use of simulation has provided another tool for educators to bridge the gap between knowledge and real environments without putting patients at risk. This allows the provider the ability to practice high-risk procedures in which you need to think quickly, but do not get the opportunity to see often in practice.
For example, in training new physicians in delivering babies, the technology can be used to practice uncomplicated births, all the way to a delivery fraught with difficulties. Birthing simulators can not only mimic the different challenging delivery scenarios a physician may encounter, but can also copy the entire delivery process all the way through the postpartum phase.
This simulator allows the entire care team to be trained to handle all situations they may encounter, with no risk to any human life during the education process — high-stakes, low-risk learning.
In the training of healthcare providers, it has been common practice to use simulation to determine competency in students prior to allowing practice on real patients, such as performing physical assessment skills and starting IVs. However, the use of simulation has bridged over to hospitals in the competency assessment of staff.
Melinda Armstrong, a certified healthcare simulation educator, noted that many hospitals she worked with would bring the simulators to the hospitals to assess the nursing staff's training and assessment of patients. They were frequently used in labor and delivery to assess the staff in the care of high-risk patients, such as those who might be experiencing postpartum assessment.
Prior to many medical devices being used on actual patients, their use is often tested on simulated patients under typical conditions. Simulations are also used to recreate a situation that may have a bad outcome and introduce a new process or device to determine efficacy and possible process improvement.
The use of sim-based research continues to be an evolving area as technology continues to evolve.
When a healthcare system wants to make a change, the use of simulation is often used to test the new processes or look for areas of improvement. New procedures may be tested in controlled environments, such as disaster training or creating a virtual learning environment prior to implementation of a new electronic health record.
Robert Blum, lead simulation technician at Johns Hopkins College of Medicine, noted that they often take their simulation manikins to the hospital for "in-situ" training. For example, having the simulation of a visitor collapsing in the lobby and evaluating the system response of the staff. They can then provide feedback and suggestions on how to improve processes in the attempt at improved patient safety and better outcomes.
As healthcare evolves and changes, so will the technology available for more effective use of simulations in the training of providers for better patient outcomes and the prevention of errors. However, for any simulation experience to be successful, it must have trained facilitators.
Marisa Belote, RN, director of the Virtual Simulation Center at University of South Florida's College of Nursing noted that just as with any teaching tool, the educator must have clear objectives, a plan and a process for evaluation for it to be profitable for the learner.
Therefore, as we strive to improve our patient safety, we must also evolve our educators to meet the needs of the new healthcare arena.
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