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+++++++++++++++++++++++++++++++++++++ + + +++++++++++++++++++++++++++++++++++++ SPECIAL SECTION: TECHNOLOGY +++ +++ Patient Safety B By Mary Patterson, MD EFORE THE INSTITUTE of Medicine released its 2000 report "To Err is Human: Building a Safer Health System," which encour- aged the use of simulation to enhance patient safety and prevent medical errors, simulation programs designed to replicate clinical experiences were uncommon. If a physician, resident, nurse or other prac- titioner required experiential learning, it typically came from hands-on experience with patients. Today, clinical simulations which create an experience that elicits the behaviors and emotions seen and felt in real-life health care situations, are becoming standard practice and helping to vastly improve patient safety. On its most basic level, a simulation program re-creates realistic situations to improve technical expertise, strengthen multidisciplinary teamwork and individ- ual performance, and enhance high-level communications among physicians, nurses and other health care providers. This is accomplished using equipment such as high-tech mannequins, standard- ized patients, task trainers and tabletop computer simulators that mimic potential occurrences to provoke real responses in the trainee. These include a heightened sense of anxiety and realistic stress level, without posing any risk to human life. Because human patients are not typi- cally involved procedurally, simulation programming allows health care provid- ers to make and learn from mistakes Key to Enhancing Simulation Training without the consequences that might occur in an operating room or clinical setting — especially with high-risk procedures. It also allows participants to gain experience and expertise in areas of practice they may encounter infrequently, creating the experience of graduated challenges they might not receive in an actual clinical setting. Simulation programs can tackle every- thing from usability testing — how a system will work or how a new space will function within a health care facility — to mass casualty or disaster simulations. The flexibility of mass casualty simulations allows for hybrid programming. This can include a mix of critical patients portrayed by mannequins and human volunteers, as needed, to serve as the less serious "walk- ing wounded," in addition to elements provided by computer-based simulation. This type of scenario is more representative of the reality that would be encountered in a disaster situation. Without simulation, obtaining this authentic atmosphere would be nearly impossible. Although simulation training is now accepted by a number of schools, hos- pitals and other health care facilities, penetration remains variable. At some institutions, only residents have access to simulation training; whereas only personnel in anesthesia services may train at a neighboring institution. Despite this, facilities today have a deeper understanding and appreciation 20 | Cleveland-Akron-Canton MD NEWS ■ MDNEWS.COM ■ SEPTEMBER-OCTOBER 2012 for the benefits derived from simulation training compared to 15 years ago. As the discipline has increased in popularity, more literature has been released dem- onstrating the effectiveness of simulation training, including an improvement in catheter-related bloodstream infections (cost and rate), neonatal outcomes and significant safety events. These favorable findings have allowed the discipline to evolve and mature into a distinct profession, similar to other specialties, with a clear set of competencies and efficiencies, skill sets, and certification and accreditation programs. Although the industry isn't quite there, the hope moving forward is that no practitioner would perform in a clinical setting without simulation training. This type of experiential learning should be part of any health care provider's everyday work, not just a once- or twice-a-year event, or for a procedure that is different or special. Testing in a simulated setting should be employed to practice techniques, explore procedures, or when a facility is considering a new equipment purchase or trying out a new process. It should be considered a vital part of how we, as health care professionals, do our best to take care of our patients. Dr. Mary Patterson is board-certified in pediatric emergency medicine and serves as the director for the Akron Children's Hospital Simulation Center for Safety and Reliability. ■