Wednesday, March 11, 2009

Cardiac surgery team simulates surgery

cardiac surgery

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 vascular bleeding. All of a sudden, the situation is emergent, and the lead thoracic surgeon calls in a cardiac surgery team to assist.

To those involved, everything about this impending crisis is real – from the communication to the palpable anxiety in the room. In reality, the whole scenario is staged. The thoracic surgeon is an actor, and the 54-year-old male patient is actually a full-featured mannequin simulator.

Massachusetts General Hospital’s cardiac surgical teams are currently participating in these lifelike operating room simulations, a training regimen designed to reduce medical errors by drilling staff in emergent situations. At the Center for Medical Simulation in Cambridge, Massachusetts, eight to 10 people from various clinical disciplines work through the simulations as a team then analyze the clinical and behavioral aspects of the 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 Mass General Hospital.

The cardiac team’s simulations are modeled after those done in other high-stress, high-risk fields, such as the airline industry and the military. A few years ago, Dr. Agnihotri had the idea of modeling cardiac OR training after the drills done in these fields because the principles of the situations can be similar.

“Our goal is to gather knowledge from these other industries about team performance,” explains Dr. Agnihotri. “If we can look at how people in other high performance industries work together in high stress situations, we can improve our own responses.”

Much like the airline industry, Dr. Agnihotri believes that cardiac OR teams can learn from drills for practice specific scenarios that, while rare, may occur during a procedure. The drills can also encourage behaviors that improve quality and safety, such as repeating back instructions and taking procedural timeouts. The Center for Medical Simulation proved to be in ideal location to bring the drill to life because of its highly-realistic simulation environment.

“Day after day nothing unusual happens, but the day that something does happen those practice drills may prove critical,” says Dr. Agnihotri.



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