Friday, April 24, 2009

MGH surgery teams participate in simulation surgery

Simulation scenario: MGH clinicians from various disciplines take part in an OR simulation.

A 54-year-old male patient is undergoing the surgical removal of a cancerous lung tumor. The procedure is moving along smoothly until the surgical team encounters
unexpected bleeding. Suddenly, the situation is an emergency, and the lead thoracic surgeon calls in a cardiac surgery team to assist.

To those involved, everything about this situation is real – from the communication to the palpable anxiety in the room. In reality, the whole scenario is a reproduction of an operation, and the 54-year-old male patient is actually a fully featured mannequin simulator.

MGH’s cardiac surgical teams are currently participating in these lifelike operating room (OR) simulations as part of training designed to reduce medical errors by drilling staff in emergent situations. At the Center for Medical Simulation in Cambridge, eight to ten staff members from various clinical disciplines work through the simulations as a team and then analyze the clinical and behavioral aspects of their performance.

“We look at how the team responds to problems and how they work together to make the surgery more effective,” says Arvind Agnihotri, MD, director of Cardiac Surgery Quality Improvement at MGH.

The cardiac team’s simulation drills are modeled after those performed in other high-stress, high-risk fields, such as the airline industry and the military. The cardiac OR simulation teams, like teams in these fields, can learn from practice exercises and become familiar with specific scenarios that, while rare, may occur during a procedure. The drills also can encourage behaviors that improve quality and safety, such as repeating back instructions and performing procedural timeouts. The Center for Medical Simulation, founded under the leadership of Jeffrey Cooper, PhD, of MGH Anesthesia and Critical Care, proved to be an ideal location to bring the exercises to life because of its highly realistic OR environment.

Following the simulation, participants gather to watch a video of the training and discuss where improvements could be made. Analyzing the team’s communication and interactions often uncovers potential problems. Everyone is encouraged to share feedback.

“The videos of the simulations help define the roles of each member of the team and improve the communication process,” says Lisa Morrissey, RN, MBA, CNOR, nursing director for the Operating Rooms. “Being able to clearly communicate saves patients’ lives.” 

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