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Patients may benefit from operating room team simulations

Media Release

University of Auckland

2 October 2014

Patients may benefit from operating room team simulations

Shorter hospital stays and reduced complication rates may be the result of new team-orientated simulation-based training being pioneered by the University of Auckland.

Teams of senior clinicians were gathered together to work as they normally would without risk to patients in an attempt to change the culture of teamwork, communication and patient safety in the operating theatre.

“Death and disability from unintended avoidable adverse events is high around the world and results in a huge global burden”, says study lead Associate Professor Jennifer Weller, who is an anaesthetist and director of the University of Auckland’s Centre for Medical and Health Science Education. “If we can help solve this problem, we can make a big impact on patient health and safety,” says Dr Weller.

“Research has shown that communication is a contributing factor to more than 60% of avoidable patient harm. Training together is one way to improve this and simulation is an ideal method.”

The multi-disciplinary team training that included surgeons, nurses, anaesthetists, and anaesthetic technicians, was carried out for the Multidisciplinary Operating Room Simulation (MORSim) study at the University of Auckland’s Patient Safety Simulation Centre in Tamaki. Worldwide, this is one of the first simulation-based training opportunities for all team members to engage in together.

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Most simulation training is conducted for individual specialties.

“The main reasons that this sort of work is not done worldwide is the cost, the need for realism, and the challenge of getting all the disciplines together and engaged”, says Dr David Cumin, a lecturer in anaesthesiology. “We were able to achieve this with the support of our funders; a special effects company; and a large, multidisciplinary team.”

The Auckland study was a pilot and involved 120 staff in total (20 teams of six).

The MORSim study was set up to improve effective team communication with a focus on sharing information among the whole operating room team. The course was designed to give participants a better understanding of the need for information sharing, expose their assumptions, identify stressors and barriers to effective teamwork, and provide a setting in which participants could reflect on their practice and come up with ideas for improved communication.

To highlight these objectives, before each simulation every team member was given a brief of the case with a critical piece of information that no one else got. Discussion after the scenario could then be around why these clinically important pieces of information were or were not shared.

The simulations included realistic patient manikins with novel surgical models all within a realistic environment and with real equipment. The scenarios were based on real patient cases that members of the large research team had experienced before.

“All the scenarios were based on real-life cases that require strong clinical coordination among all team members” says study co-author, Dr Cumin. “We used a special effects company to increase the realism by creating models for surgeons to actively engage with as this has been a barrier to previous attempts at this work.”

“Each scenario included a handover, the initial crisis period, and on-going treatment,” he says. “Often the participants were so deeply involved in treating the ‘patient’ they were reluctant to leave when we tried to stop the simulation.”

Communication tools presented to the participants over the day included briefings (including the WHO checklist), closed loop communication, and structured call-outs. Debriefs after each scenario, didactic lectures, and time together in breaks are all thought to be contributing factors to the success of the pilot.

The study design included observations of 437 real clinical cases and rating the team performance for information sharing, inquiry, vigilance and awareness, and inter-team information sharing. This is a modified version of a tool that was developed in the USA and has been related to adverse events, called the behavioural marker of risk index (BMRI). Results show a significant improvement in team performance and work is being done to identify any change in patient outcome.

There were many positive participation evaluations from the day’s training with many saying they would go back into the clinical environment and do things differently,

“The debriefs produced ideas on how to improve things in the clinical environment. We certainly challenged participants’ assumptions about working together as different disciplines and the need for an atmosphere of trust and collaboration,” says Dr Cumin. “The challenge is to transfer these new communications skills into clinical practice. More than 60 percent of participants said they now feel more confident to speak up in the operating room setting, after this one day course.”

“There are still barriers to change and more work to be done, but this is a good start,” says Dr Cumin. “Better communication in the operating room should result in fewer adverse events and improved patient safety.”

In future it is hoped the team will be able to pilot the simulations outside of the simulation centre and into the hospital setting and eventually roll it out into New Zealand hospitals so that it becomes normal practice training for multi-disciplinary operating teams.


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