Simulation of Code Stroke Jenny Simmonds, RN Simulation Program Manager, Registered Nurse, Intermountain Healthcare; Salt Lake City, UT Objectives: • Identify the history of development of simulation within Intermountain Healthcare • Describe simulation can help you reach high reliability of care for the acute stroke patient • Practice simulation demonstration of the NIH scale
Why Simulation? Lessons Learned from Time “In the Box” Angie Kahoush MSN, RN South Region Simulation Manager Phillip Wortham BA System Simulation Manager for Operations and Technology
Disclosure No financial conflicts to disclose
Objectives • Why Simulation? Explore what healthcare can learn from Aviation Teamwork and Safety • Discuss the Intermountain Healthcare simulation structure/updates • Discuss Improvement in engagement of signature initiatives through simulation
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Simulation Training Methodology for learning in which trainees are: • Immersed in a realistic scenario • THINK, TALK and DO • Go beyond comfort level • Reflect on performance in debriefing following scenario • Trained as a team • No better place to make a mistake When I do it correctly; I gain experience. When I do it poorly; wisdom. Mistakes are the portals of discovery.” ‐ James Joyce (Irish Poet)
Developing Evidence “A growing body of evidence shows that clinical skills acquired in medical simulation laboratory settings transfer directly to improved patient care practices and better patient outcomes.” (Academic Medicine June 2011)
Simulation Training • Aviation • Nuclear power • Military • Law Enforcement These industries have very low failure rates considering the inherent risks, but it wasn’t always so…
United Airlines Flight 173 Portland, Oregon 12/28/1978 • Flight from New York to Portland, stopped in Denver • 46,700 lbs fuel when departed Denver, 31,900 lbs needed to reach Portland • Crashed 6 miles from Portland airport • Spent 54 minutes spent troubleshooting • Flight engineer questioned fuel levels 38 minutes into troubleshooting process • 10 killed including flight engineer, 23 seriously injured
Lessons Learned “Crew members must be The risk associated with a proactive, coordinating team’s preoccupation individual efforts to yield with an emergency can effective team exceed the risk posed by performance… As with the emergency itself. athletics, a group of individuals with superior talent may be bested by In this case, the crew another group of more spent 54 minutes modestly talented troubleshooting a individuals who work problem that was not the together successfully as a primary problem… team.” ‐ Donald Davis , Pilot, Author
Cockpit Resource Management (CRM) 1979 NASA research identified that human error was the primary cause of most aviation accidents… Human errors that lead to the majority of air crashes: • Interpersonal communication • Decision making • Leadership • Teamwork • Problem Solving
Aviation on Burning Platform We change because the price of staying on the platform is too high. Radical change in people only comes when survival instincts trump comfort zone instincts.
Relation to Healthcare Inherent risk to human life – Direct relationship between actions and outcomes – Technical skills are vital – Communication is primarily verbal and immediate – Involves multiple personnel – Human interface with technology – Tradition of senior pilot and Physician as commander in chief –
Cockpit Resource Management to Crisis Resource Management Communication Developed by team Global Assessment of anesthesiologists Role Clarity in 1990 Personnel Support Resources
Our “Burning Platform” • 2014 issue in Journal of Patient Safety report numbers ranging from 210,000 to 400,000 deaths/yr. • 3 rd leading cause of death 2 nd to heart disease and cancer. Odds of dying in a plane crash: 1 in 14 million John Hansman Jr., Director MIT International Center for Transportation ( 761 deaths from airline crashes in 2014) ‐ Aviation Safety Network
Relation to Healthcare “Many of these poor outcomes are not due to inadequate medical knowledge, but to problems transforming that knowledge into meaningful clinical actions under the real world conditions of patient care.” (Rall & Dieckmann)
Why would we not use Simulation?
How can Simulation Help? Simulation allows participants an opportunity to practice real world situations (CRM) in a safe environment where there is no risk of harm to patients, thus bridging the gap between learned knowledge and real life application.
Debriefing with Good Judgment
Potential + Training – Interference = High Performance PO + T – I = HP • Practice makes permanent • Navigate in the critical moment • Help employees acquire skills = Permanently changing people • No individual is perfect….but you can have a perfect team
Miracle on the Hudson January 15, 2009 “I had to force myself to use my training and enforce calm on the situation… my entire life up to that moment had been in preparation to handle that particular moment.” Pilot Chesley Sullenberger
"One way of looking at this might be that for 42 years, I've been making small, regular deposits in this bank of experience: education and training. On January 15, the balance was sufficient so that I could make a very large withdrawal." ‐ Chesley Sullenberger
Intermountain Healthcare Simulation VIDEO
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