Simulation in healthcare : journal of the Society for Simulation in Healthcare
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Simulators are used extensively for the training of medical personnel. All anesthesia providers should be prepared and trained in the management of one lung ventilation for pulmonary surgery, yet familiarization with one lung ventilation may not be possible on a routine basis in the operating room. Therefore, this reports details the first use of the patient simulator (PS) to enhance the training of anesthesia residents in the management of one lung ventilation. A detailed report of our computer program for simulating one lung ventilation is included.
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Management of pediatric cardiopulmonary arrest (CPA) is challenging because of the low volume of experience of most pediatric health care providers. Use of cognitive aids may assist in making rapid decisions in these crises; however, there are no known published reports on whether these aids are actually used during arrest management and whether they impact quality of care. ⋯ Eighty-five percent of residents voluntarily used a cognitive aid to assist in managing simulated pediatric CPAs. The most commonly used aids were an American Heart Association Pediatric Advanced Life Support aid and an institutionally created aid. Forty-three of 51 (84.3%) and 23 of 46 (60.5%) residents used these aids for assistance with the pulseless ventricular tachycardia and pulseless electrical activity algorithm, respectively. Unfortunately, 13 of 51 (25.5%) residents chose the incorrect treatment algorithm, resulting in inappropriate management. CONCLUSION AND APPLICATION: Although the majority of residents chose to use cognitive aids for assistance, errors in management were common. Further study is required to determine whether these errors are associated with cognitive aid design flaws and whether improving their design through human factors research can help minimize errors in Basic and Advanced Life Support, ultimately improving patient outcomes.
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Resuscitation science is a dynamic part of healthcare training, with an expanding role for simulation. Historically, performance measurement and documentation relied upon the presence of an instructor, an expensive and potentially inaccurate assessment tradition that tied performance testing to a fixed facility. We hypothesize that an automated system might be developed and validated to document performance in airway management for self assessment in the absence of a human trainer. The system would also store and transmit data to a central registry to document skill acquisition and maintenance. ⋯ This system was successfully used to document student performance of BVM, orotracheal intubation, and ventilation via ETT. The system easily integrates documentation, including text reports, airway pressure readings, still images and videos of task performance. Such digital documentation could guide skill acquisition and quantitatively certify performance with minimal reliance upon an instructor and evaluator.
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In medicine, standard setting methodologies have been developed for both selected-response and performance-based assessments. For simulation-based tasks, research efforts have been directed primarily at assessments that incorporate standardized patients. Mannequin-based evaluations often demand complex, time-sensitive, hierarchically ordered, sequential actions that are difficult to evaluate and score. Moreover, collecting reliable proficiency judgments, necessary to estimate meaningful cut points, can be challenging. The purpose of this investigation was to explore whether expert judgments obtained using an examinee-centered standard setting method that was previously validated for standardized patient-based assessments could be used to set defensible standards for acute-care, mannequin-based scenarios. ⋯ An examinee-centered approach, using aggregate expert judgments of audio-video performances, was suitable for setting standards on most acute-care, mannequin-based scenarios. It is necessary, however, to have valid scores for the chosen scenarios and to sample performances across the ability spectrum.
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Patient safety initiatives aimed at reducing medical errors and adverse events are being implemented in Obstetrics. The Controlled Risk Insurance Company (CRICO), Risk Management Foundation (RMF) of the Harvard Medical Institutions pursued simulation as an anesthesia risk control strategy. Encouraged by their success, CRICO/RMF promoted simulation-based team training as a risk control strategy for obstetrical providers. We describe the development, implementation, and evaluation of an obstetric simulation-based team training course grounded in crisis resource management (CRM) principles. ⋯ A simulation-based team-training course for obstetric clinicians was developed and is a central component of CRICO/RMF's obstetric risk management incentive program that provides a 10% reduction in annual obstetrical malpractice premiums. The course was highly regarded immediately and 1 year or more after completing the course. Most survey responders reported improved teamwork and communication in managing a critical obstetric event in the interval since taking the course. Simulation-based CRM training can serve as a strategy for mitigating adverse perinatal events.