Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based...
Transcript of Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based...
![Page 1: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/1.jpg)
Simulation-based education in optimizing patient safety and outcomes: a local experience
PP Chen
Chief of Service
Department Anaesthesiology & Operating Services
Alice Ho Miu Ling Nethersole Hospital &
North District Hospital, Hong Kong
id17196671 pdfMachine by Broadgun Software - a great PDF writer! - a great PDF creator! - http://www.pdfmachine.com http://www.broadgun.com
![Page 2: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/2.jpg)
Outline
� Is simulation-based medical education the right approach for us in HK?
� Local experience
![Page 3: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/3.jpg)
To err is human �� (1999)
![Page 4: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/4.jpg)
HA Sentinel Events 2009-2010
HA Q&S Report 2011
![Page 5: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/5.jpg)
HA Q&S Report 2011
![Page 6: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/6.jpg)
Common contribution factors to medical error
� Failure to check & detect
� Lack of training
� Ineffective communication
� Poor leadership
� Unclear role delineation
� Poor decision making
Reason J. BMJ 2000.
![Page 7: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/7.jpg)
Simulation-based medical education
� Effective learning through active learner engagement
� Hands-on experience in a �real-life� setting
� Reflective learning � immediate debrief � Errors can be allowed to occur and reach their
conclusion � Repetitive practices
� Ability to vary difficulty & complexity
� Allows training on teamwork, leadership, communication , situation awareness, decision making
![Page 8: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/8.jpg)
Areas of simulation-based medical education
� Skills acquisition� Technical eg surgical techniques
� Non-technical eg communication
� Changing behaviour� Human factors
� Team dynamics
� Assessment/credentialling � undergraduate, professional, continuous professional development
![Page 9: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/9.jpg)
What is the Evidence for Simulation-based medical training?
� Self-efficacy Taekman JM, et al. Anesth Analg 2004, Nishisaki A, et al. CritCare Med 2006
� Competence Sica GT et al. Am J Roentgenol 1999, DeVita MA et al. Qual Saf Health Care 2005, Wallin CL et al. Med Educ 2007
� Operational performance� Airway mx Mayo PH et al. Crit Care Med 2004
� Surgical procedures Chaer RA, et al. Ann Surg 2006
� Communication Berkenstadt HB, et al. Chest 2008
� Professional behaviour & attitude Weaver SJ , et al. J Quality Patient Safety 2010
� Patient outcomes difficult to measure
![Page 10: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/10.jpg)
![Page 11: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/11.jpg)
��.but is simulation-based medical education expensive?
![Page 12: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/12.jpg)
Low-fidelity vs High-fidelity
� Role play
� Standardized patients (Actor)
� Task- trainers
� Computer-based programme eg virtual reality
� Full motion computer controlled simulator
![Page 13: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/13.jpg)
Confucius551 BC � 479 BC
I hear and I forget,
I see and I remember,
I do and I understand
不聞不若聞之,
聞之不若見之,
見之不若知之,
知之不若行之;
學至於行之而止矣
![Page 14: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/14.jpg)
First do no harmPrimum non nocere
1720�s1027
![Page 15: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/15.jpg)
SBME is really a great approach for patient safety training! ......
especially for high-risk, low frequency (uncommon) medical
conditions
![Page 16: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/16.jpg)
SBME in Hong Kong?
![Page 17: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/17.jpg)
HK has come a long way ��
� Technical skill training � ACLS, ATLS, PALS, Airway management � Surgical skill training eg laparoscopy, endoscopy� Nursing education� Undergraduate teaching
� Non-technical skill� CRM eg ACRM, EMAC� Communication skill training� Team training
![Page 18: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/18.jpg)
![Page 19: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/19.jpg)
A&E Training Centre RTSKH
� Basic Life Support (BLS)
� Advanced Cardiovascular Life Support (ACLS)
� International Trauma Life Support (ITLS)
� Acute Stroke Life Support (ASLS)
� Simulated Accident & Vehicle Extrication (SAVE)
� Emergency Management of Severe Burns (EMSB)
� Public courses � BLS, Basic ITLS, Airway mgt, First Aid
![Page 20: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/20.jpg)
CMC Resuscitation Training Centre
� AHA & National Safety Council Courses� BLS
� ACLS
� PALS
� Heartsave CPR
� First Aid
� Airway Mgt
� Emergency Response Team Course
� Public courses
![Page 21: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/21.jpg)
HA Infectious Disease Simulation TrainingCentre (HAIDSTC) PMH
� Drills on infectious disease� Work in collaboration with AED, ICU, hospital
infection control teams & supporting services, CHP and DH
� Conduct simulation training program for newly qualified HA registered nurses � organized by IANS� Enhance essential core competencies in patient
assessment and proficiency in providing safe practice during medical emergency
� Train-the-trainer courses � Critical care nursing
![Page 22: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/22.jpg)
Demonstrating how to perform NPA in a safe manner
Suspected avian influenza (H5N1) � Performing endotracheal intubation
A nurse is assisting the doctor in performing a high-risk procedure � lymph node aspiration on a patient suspected of plague
Ambulance Depot in the Hospital Authority Infectious Disease Centre - A woman with suspected avian influenza
![Page 23: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/23.jpg)
HKEC Training Centre, PYNEH
![Page 24: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/24.jpg)
Crew Resource ManagementPatient Safety
� Aim to enhance communication and cooperation of the hospital staff and medical teams to reduce hospital incidents and ensure patient safety
� Pilot in PYNEH, training of 1400 staff 2010-2011
� Using local cases for illustrations
� In the evaluation phase
![Page 25: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/25.jpg)
PYNEH
� Simulator instructors course in March 2011, conducted by the Harvard�s Simulation Centre team
� Fully staff to provide training for HKEC�s & other HA healthcare professionals
� Minimal Access Surgery Training Centre� Spacious with advanced computer-controlled
surgical skill training simulators
� Surgical skill training
![Page 26: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/26.jpg)
NTWC Clinical Skill Training Centre Tuen Mun Hospital
![Page 27: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/27.jpg)
![Page 28: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/28.jpg)
Multidisciplinary Simulation & Skill Centre, QEH
� Recently held a simulation instructor course conducted by the WISER group, University of Pittsburg in May 2011
� ATLS
� Resuscitation courses
� Endovascular surgical skill training
![Page 29: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/29.jpg)
University Postgraduate Training Centres
� HKU JC Skill Development Centre QMH� ATLS, ACLS
� CUHK JC Minimally Invasive Surgical Skill Centre PWH
� CUHK Orthopaedic Skill Lab, PWH
![Page 30: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/30.jpg)
NDH Institute of Clinical Simulation� Anaesthesiology-training course
� Effective Management of Anaesthesia Crisis (EMAC) 2004-
� Exposure to Anaesthesia Safety & Emergencies (EASE) for new trainees
� Crew resource management courses� Anaesthesia Crisis Resource Management (ACRM) 2001-
� Management of Anaesthesia Clinical Emergencies (MACE)
� Medical Intervention of Clinical Emergencies (MICE) for different medical specialties
� Nursing Intervention of Clinical Emergencies (NICE)
� Airway management courses� Advanced & Difficult Airway Management � Anaesthesiologist (ADAM-A)
� ADAM- N for nurses
� ADAM- D for doctors from all medical specialties
� Others � Safe sedation course for doctors and nurses from different medical specialties
� HA Junior Doctors� Essential Basic Clinical Skills Course
� Team-CPR workshop for different medical specialties
� Instructors courses & refreshers
![Page 31: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/31.jpg)
![Page 32: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/32.jpg)
Usual CRM course format
![Page 33: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/33.jpg)
Medical Intervention of Clinical Emergencies Course 2009
94.6% 75.8% 70.8% 91.0% agree or strongly agree
MICE Evaluation from 56 participants
0
20
40
60
80
Rel
evan
ceof
trai
ning
Wor
k m
ore
safe
ly
Cha
nge
prac
tice
Rec
omm
end
othe
rs
Per
cen
tag
e
Strongly disagree
Disagree
Undecided
Agree
Strongly agree
Mean scores + SD 4.2+0.5 3.9+0.7 3.9+0.7 4.1+0.7)
94.5% 75.8% 70.9% 91.0%
![Page 34: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/34.jpg)
Subsequent Follow-up 2011 � n=65, response rate 54%
� 55 experienced one or more (median 3, range 0-7) medical emergencies after the course
� The most common types of event were
� shock (45), cardiac arrest (41), airway crisis (33).
� Forty seven (72.3%) perceived that lessons learned during the course were helpful in managing their clinical emergencies
� The respondents� attitude towards principles of crisis management showed significant improvement in all aspects (p<0.001)
![Page 35: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/35.jpg)
Team-CPR course
� Participants agreed that� the course has achieved its
stated objective (5.28+0.46)
� the course content was practical for their workplace (5.44+0.51)
� their learning in the course was enhanced by the experiential education process (5.33+0.49 )
� they were satisfied with the course as a whole (5.33+0.49)
� Behavioural aspects, communication and team interaction issues and deficiencies in other non-technical areas were observed
![Page 36: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/36.jpg)
Is SBME the answer?
� SBME is only just a tool to enhance learning & training
� In order to be effective it has to be implemented appropriately
� SBME trainers and raters have to be properly trained
� Organisational support and additional resources
� Outcome evaluation and course review
![Page 37: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/37.jpg)
See one, do one, teach one
![Page 38: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/38.jpg)
See one, practice many times on simulator, do one, teach one
��..and learn about communication, teamwork,
decision making
![Page 39: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/39.jpg)
Asia Pacific Meeting on Simulation in Healthcare 2011
New Horizons Grand Hyatt, Hong Kong 19/05/11 - 22/05/11
![Page 40: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/40.jpg)
![Page 41: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/41.jpg)
We still have a long way to go in HK!
![Page 42: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/42.jpg)
Summary
� Patient safety remains a major priority in HA
� There is a general shift of teaching approach toward high-fidelity SBME in HK healthcare
� SBME in healthcare is still relatively new to us
� Concern about cost-effectiveness
� What direction � single vs multiple centres
� Various centres need to work together to come up with a comprehensive programme for HA & HKAM
![Page 43: Simulation-based education in optimizing patient safety and … · 2011-07-07 · Simulation-based education in optimizing patient safety and outcomes: a local experience PP Chen](https://reader033.fdocuments.us/reader033/viewer/2022041910/5e66d762904b5b1e4a4f61d4/html5/thumbnails/43.jpg)
Thank [email protected]
Acknowledgement
Dr Libby Lee, HAHO
Dr WK Ching, HAHO
Dr CC Lau, HKEC Training Centre, PYNEH
Dr CW Kam, NTWC Clinical Skill Training Centre, TMH
Ms OM Ho, HA Infectious Control Simulation &Training Centre, PMH