Simulation technology in critical care:
This presentation is the property of its rightful owner.
Sponsored Links
1 / 49

Randy S. Wax, MD, FRCP(C) Technology Application Unit and Critical Care Unit, Department of Medicine, Mount Sinai Hospital Lecturer, Department of Medicine, PowerPoint PPT Presentation


  • 58 Views
  • Uploaded on
  • Presentation posted in: General

Simulation technology in critical care: 1000 deaths for medical education Technology for teaching and evaluating critical care knowledge, skills and attitudes. Randy S. Wax, MD, FRCP(C) Technology Application Unit and Critical Care Unit, Department of Medicine, Mount Sinai Hospital

Download Presentation

Randy S. Wax, MD, FRCP(C) Technology Application Unit and Critical Care Unit, Department of Medicine, Mount Sinai Hospital Lecturer, Department of Medicine,

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Simulation technology in critical care 1000 deaths for medical education technology for teaching and evaluating crit

Simulation technology in critical care: 1000 deaths for medical educationTechnology for teaching and evaluating critical care knowledge, skills and attitudes

Randy S. Wax, MD, FRCP(C)

Technology Application Unit and Critical Care Unit,

Department of Medicine, Mount Sinai Hospital

Lecturer, Department of Medicine,

University of Toronto


Learning objectives

Learning objectives

  • Why simulation?

  • Features of a simulator

  • Apply simulation technology

  • Limitations and resource requirements


A traditional approach to learning

A traditional approach to learning


Problem 1

Problem #1

  • Just because students learn a task in the classroom doesn’t mean they can demonstrate successful performance during a crisis.


Problem 2

Problem #2

  • Some clinical experiences are so life threatening that students are not going to be involved in the management.


Problem 3

Problem #3

  • Some are so rare that the student may not ever experience the situation until they are in the midst of caring for the patient.


Different simulation formats

Different simulation formats

  • Patient management problems (paper/pen)

  • Computerized simulation

    • Internet-based

  • Role playing/standardized patients

  • Mannequin-based (e.g., CPR BCLS trainer)

  • Virtual reality


Why simulation

Why simulation?

  • Used in many “high reliability” fields

    • Aviation

    • Nuclear power

    • Military flight operations


Why simulation1

Why simulation?

  • No risk to patients

  • Many scenarios can be presented, including uncommon but critical situations in which a rapid response is needed

    • E.g. malignant hyperthermia 1:40,000 cases

  • Participants can see the results of their decisions and actions; errors can be allowed to occur and reach their conclusions


Why simulation2

Why simulation?

  • Identical scenarios can be presented to different clinicians or teams

  • The underlying causes of the situation are known

  • With mannequin based simulators clinicians can use actual medical equipment

    • examine limitations in the human-machine interface


Why simulation3

Why simulation?

  • Re-create clinical environments

    • Assess interpersonal interactions with other clinical staff

    • Evaluate and improve teamwork, leadership, and communication skills


Why simulation4

Why simulation?

  • Intensive and intrusive recording of the simulation session is feasible

    • Audiotape

    • Videotape

    • Physiological monitoring of participants (EEG, ECG, etc.)


Why simulation5

Why simulation?

  • There are no issues of patient confidentiality

  • Recordings can be preserved for research, performance assessment, or accreditation


How can we use simulation

How can we use simulation?

  • Skills training

  • Evaluation

  • Epidemiology and modification of errors (and their consequences)

  • Crisis resource management


What can you teach evaluate

What can you teach/evaluate?

  • Specific skills

    • Intubation

    • Bronchoscopy

    • Defibrillation

  • Integration of knowledge, skills and decision making

    • Resuscitation

    • Refractory hypoxemia


Evaluation of the evaluation tool

Evaluation of the evaluation tool

  • Type of simulator

    • Low to high fidelity

  • Type of simulation

    • Full theatre environment or real location

    • Training device for specific tasks

  • Efficacy of assessment

    • Valid

    • Reliable


Sim man

SIM MAN


Life size mannequin

Life-size mannequin


Computer controlled

Computer Controlled


Teach airway management

Teach airway management


Use airway devices

Use airway devices


Fibreoptic intubation

Fibreoptic intubation


Simulation technology in critical care 1000 deaths for medical education technology for teaching and evaluating crit

  • Difficult airway

    • Decreased cervical range of motion

    • Tongue edema

    • Pharyngeal edema

    • Laryngospasm

    • Trismus

    • Fiberoptic intubation/bronchoscopy

    • Surgical airway

    • Detectable carbon dioxide


Breath sounds

Breath sounds


Check pulse blood pressure

Check pulse & blood pressure


Obtain peripheral iv access

Obtain peripheral IV access


Mask ventilation

Mask ventilation


Decompress tension pneumothorax

Decompress tension pneumothorax


Monitor cardiac rhythm

Monitor cardiac rhythm


Shock unstable rhythms

Shock unstable rhythms


Additional features

Additional features

  • Chest tube insertion

  • Invasive hemodynamics

  • Ventilator management (including HFOV)


Control crisis situations

Control crisis situations


Give feedback

Give feedback


Assessment instruments

Assessment instruments

  • Specific

    • Debriefing (oral or written…good for factual)

    • Observation and scoring system (checklist or score sheet or palm pilot)

    • Time to performance of specific task

  • Global

    • Simulated mortality as end-point

    • Time to solve problem


How can we use simulation1

How can we use simulation?

  • Skills training

  • Evaluation

  • Epidemiology and modification of errors (and their consequences)

  • Crisis resource management


Epidemiology of medical error

Epidemiology of Medical Error

  • Types of errors made during anaesthesia simulation

Schwid and O’Donnell Anesthesiology 1992


Crisis resource management

Crisis Resource Management

  • Using all available resources during a crisis to achieve safety and efficiency

    • Information

    • Equipment

    • People


Crisis resource management1

Crisis Resource Management

  • Error countermeasures

    • Reduce the frequency of errors

    • Correct errors

    • Limit the impact of errors


Resources

Resources

  • Simulator PLUS operational budget

  • Competency standards

    • Who/what are you testing?

  • Content experts

    • Set objectives and clinical setting

  • Simulation experts

    • Translate objectives and clinical setting into functional simulation scenarios

  • AV equipment (debriefing)


Limitations of simulation

Limitations of simulation

  • Difficult to demonstrate improved outcome from use of simulation

    • Adverse events are unusual

    • Extreme number of potential confounders

  • Forced to use simulation performance as surrogate outcome


Initiatives at msh

Initiatives at MSH


Initiatives at msh1

Initiatives at MSH

  • Mock cardiac arrests

    • ACLS protocols

    • Use of equipment

    • Systems issues (elevators, cancel arrest)

    • Crisis resource management

    • Feedback/debriefing


Initiatives at msh2

Initiatives at MSH

  • Life-saving delegated medical acts

    • ICU/CCU nurses

    • Use of epinephrine/atropine

    • Defibrillation

  • Pre-ACLS interventions

    • Bag-valve-mask ventilation

    • Understanding respiratory failure and shock


Initiatives at msh3

Initiatives at MSH

  • Medical and Critical Care Residents

  • Continuing education courses

    • Difficult airway management

    • Advanced ARDS strategies

  • Technology evaluation

    • OCCIN Project

      Multidisciplinary approach

      Portable


Parting comments

Parting comments

  • Simulation is fun for students and teachers

  • You can use simulation technology as an evaluation tool

  • Choose the most appropriate tool for achieving educational goals

  • Remember basics of education, otherwise simulator is an expensive toy


  • Login