This ED uses simulators to reduce pediatric errors
While patient simulators can clearly be used to assess the performance of ED staff in pediatric trauma cases, they also can be used to improve their performance in these cases. That’s what the ED at Cincinnati Children’s Hospital Medical Center has been doing since May 2002.
More specifically, they are using these simulators to improve communications among the different members of the trauma team. This step is being accomplished by having them train as a team, explains Mary Patterson, MD, MEd, principal investigator of a $243,000 grant from the Agency for Healthcare Research and Quality that is funding these efforts. Patterson also is an emergency physician at Cincinnati Children’s and associate professor in the Division of Emergency Medicine, University of Cincinnati College of Medicine.
"In our pediatric emergency department, we are involving nurses, doctors, respiratory therapists, paramedics, and patient care assistants," she reports. "We are training on them as the teams that we work in; we are not just training doctors or nurses in isolation — in silos.’" Silos are an impediment to smooth communications, she says. "They do not make sense, because that’s not the way we work," Patterson says.
Creating high-risk scenarios
Currently, the ED is using three simulators: an infant, a pediatric patient, and an adult, says Patterson. The simulators were purchased from two manufacturers: Medical Education Technologies Inc. (METI), of Sarasota, FL, and Laerdal Medical Corp. of Wappinger Falls, NY. The pediatric simulator cost about $225,000, she says. The infant one was about $40,000, because it had lower fidelity, she says.
Why the adult simulators? "We have a partnership with an Air Force training program — people rotating in and out of Iraq who need to be trained around air transport," says Patterson, who notes that the Air Force bought the adult simulator.
"We create scenarios that replicate higher-risk situations in the department — in particular, rare events," she explains. "One rare event we might deal with would be an adult having chest pain or an MI in here," Patterson says. "We have a whole lot of grandparents, parents, and staff, so even though this is a pediatric hospital, we have lots of opportunities for adults to go down."
As part of the drills, equipment malfunctions are created and distractions are introduced — such as people who play the parent. Parents are allowed in the treatment rooms at Children’s and naturally will become upset on occasion, Patterson notes.
They also address situations in which there are obstacles to communications, such as when somebody has to challenge authority, she says.
The teamwork and behavioral aspects the program teaches are very valuable, Patterson says. "There are other ways to learn cognitive information, but to really develop teamwork behaviors you have to really do it," she says. "In the case of an authority gradient, when [someone in higher authority is not doing the right thing and] someone junior has to challenge someone senior, you will learn how much anxiety there is, and know what to do if and when it happens in a real case." Working through emotions and knowing what you need to do to make assertive statements in such situations are one of the most valuable benefits of simulation, adds Patterson.
She says all EDs should consider the use of simulators. "It has become incredibly important, she says. "There is increasing recognition that humans are not very good at dealing with infrequent, high-risk events if they do not practice the behaviors needed to do well."
For example, Patterson notes, she might see an adult with an MI every two years — which is not adequate preparation. "This allows us to practice both the cognitive and behavioral skills needed to manage these cases effectively and competently and allows us to do it safely — without making a mistake on the patient," she says.
Sources/Resource
For more information on using simulators to train for pediatric trauma cases, contact:
- Mary D. Patterson, MD, MEd, Associate Professor, Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., ML 2008, Cincinnati, OH 45229. Phone: (513) 636-4239. Fax: (513) 636-7967. E-mail: [email protected].
For more information on purchasing simulators, contact:
- Laerdal Medical Corp., 167 Myers Corners Road, P.O. Box 1840, Wappingers Falls, NY 12590-8840. Phone (800) 431-1055 or (845) 297-7770. Fax (800) 227-1143 or (845) 298-4545.
- Medical Education Technologies Inc., 6000 Fruitville Road, Sarasota, FL 34232. Phone: (866) 233-6384.
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