Education and simulation techniques for improving reliability of care

Purpose of reviewMultiple factors influence the dependability of intensive care provision. The management of a group of unstable, critically ill patients requires focused attention from the clinical team. Medical simulation is an important tool to improve safety and team work within the ICU. Recent findingsThe critical care healthcare team needs to work both individually and together in such a way as to optimise patient care and prevent error. This involves nontechnical skills including decision making, task allocation, team working and situation awareness, all of which are underpinned by communication, cooperation and coordination. The use of integrated simulators to create realistic patient scenarios with structured debriefing is an excellent method for teaching in these domains. There has been a huge increase in the delivery of training and education using an expanding variety of clinical simulators. SummaryThis review summarises the evidence and opinion about how simulation tools can be optimally used. In addition, we propose an educational strategy to optimise the impact on clinical practice by embedding simulation training in a multidisciplinary teaching programme based upon a specifically developed curriculum focusing on the teaching of crisis resource management and patient safety.

[1]  J Bryan Sexton,et al.  Discrepant attitudes about teamwork among critical care nurses and physicians* , 2003, Critical care medicine.

[2]  J. Cooper,et al.  A brief history of the development of mannequin simulators for clinical education and training , 2004, Quality and Safety in Health Care.

[3]  R. Steadman,et al.  Simulation-based training is superior to problem-based learning for the acquisition of critical assessment and management skills* , 2006, Critical care medicine.

[4]  R. Glavin,et al.  Integrating human factors into the medical curriculum , 2003, Medical education.

[5]  R. Flin,et al.  The role of non-technical skills in anaesthesia: a review of current literature. , 2002, British journal of anaesthesia.

[6]  P. Croskerry,et al.  Patient safety: a curriculum for teaching patient safety in emergency medicine. , 2003, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[7]  A. Ziv,et al.  Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review , 2005, Medical teacher.

[8]  J Rogalski,et al.  10 Training for collective competence in rare and unpredictable situations , 2002 .

[9]  Amy L. Seybert,et al.  Pharmacy student response to patient-simulation mannequins to teach performance-based pharmacotherapeutics. , 2006, American journal of pharmaceutical education.

[10]  Shawna J Perry,et al.  Human factors and ergonomics in the emergency department. , 2002, Annals of emergency medicine.

[11]  Michelle Chiu,et al.  A pilot study using high-fidelity simulation to formally evaluate performance in the resuscitation of critically ill patients: The University of Ottawa Critical Care Medicine, High-Fidelity Simulation, and Crisis Resource Management I Study , 2006, Critical care medicine.

[12]  Sonya Canzian,et al.  Using simulation for training and to change protocol during the outbreak of severe acute respiratory syndrome , 2005, Critical care.

[13]  Rosemarie Fernandez,et al.  The use of simulation in emergency medicine: a research agenda. , 2007, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[14]  Pat Croskerry,et al.  The theory and practice of clinical decision-making , 2005 .

[15]  E. Hunt,et al.  Simulation in medicine: addressing patient safety and improving the interface between healthcare providers and medical technology. , 2006, Biomedical instrumentation & technology.

[16]  N C Boreham,et al.  Clinical risk and collective competence in the hospital emergency department in the UK. , 2000, Social science & medicine.

[17]  R. Flin,et al.  Interdisciplinary communication in the intensive care unit. , 2007, British journal of anaesthesia.

[18]  D. Gaba,et al.  Crisis Management in Anesthesiology , 1993 .

[19]  Pat Croskerry,et al.  Cognitive forcing strategies in clinical decisionmaking. , 2003, Annals of emergency medicine.

[20]  L. Lingard,et al.  Pulling Together and Pushing Apart: Tides of Tension in the ICU Team , 2002, Academic medicine : journal of the Association of American Medical Colleges.

[21]  R Flin,et al.  Teaching surgeons about non-technical skills. , 2007, The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland.

[22]  R. Flin,et al.  Identifying and training non-technical skills for teams in acute medicine , 2004, Quality and Safety in Health Care.

[23]  R. Helmreich Managing human error in aviation. , 1997, Scientific American.

[24]  Geoffrey K Lighthall,et al.  Use of a fully simulated intensive care unit environment for critical event management training for internal medicine residents* , 2003, Critical care medicine.

[25]  W. Cordell,et al.  Emergency department workplace interruptions: are emergency physicians "interrupt-driven" and "multitasking"? , 2000, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[26]  D. Gaba,et al.  Emergency medicine crisis resource management (EMCRM): pilot study of a simulation-based crisis management course for emergency medicine. , 2003, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[27]  V. LeBlanc,et al.  Residents feel unprepared and unsupervised as leaders of cardiac arrest teams in teaching hospitals: A survey of internal medicine residents* , 2007, Critical care medicine.

[28]  Helene Cunningham,et al.  Using Clinical Simulation to Teach Patient Safety in an Acute/Critical Care Nursing Course , 2005, Nurse educator.

[29]  J. Hardy,et al.  Anesthesia physician resources — time to change the focus , 2005, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[30]  Hilde Smith-Strøm,et al.  Improving patient safety by using interprofessional simulation training in health professional education , 2006, Journal of interprofessional care.

[31]  Enrico W. Coiera,et al.  Interruptive communication patterns in the intensive care unit ward round , 2005, Int. J. Medical Informatics.

[32]  R. Glavin,et al.  Low‐ to high‐fidelity simulation – a continuum of medical education? , 2003, Medical education.

[33]  W. B. Murray,et al.  Crisis resource management among strangers: principles of organizing a multidisciplinary group for crisis resource management. , 2000, Journal of clinical anesthesia.

[34]  P. Croskerry Commentary: The affective imperative: coming to terms with our emotions. , 2007, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[35]  G. Lighthall,et al.  Evaluating the management of septic shock using patient simulation , 2007, Critical care medicine.

[36]  K Lauche,et al.  Non-technical skills in the intensive care unit. , 2006, British journal of anaesthesia.

[37]  M. Devita,et al.  Improving medical emergency team (MET) performance using a novel curriculum and a computerized human patient simulator , 2005, Quality and Safety in Health Care.

[38]  Roslyn F Schneider,et al.  Achieving housestaff competence in emergency airway management using scenario based simulation training: comparison of attending vs housestaff trainers. , 2006, Chest.

[39]  M. Parr,et al.  Use of Human Patient Simulation in an Undergraduate Critical Care Course , 2006, Critical care nursing quarterly.

[40]  R. Flin,et al.  Anaesthetists' Non-Technical Skills (ANTS): evaluation of a behavioural marker system. , 2003, British journal of anaesthesia.

[41]  J. Dunn The November special issue on errors. , 2001, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[42]  D. Neilipovitz Acute Resuscitation and Crisis Management: Acute Critical Events Simulation (ACES) , 2005 .