A couple of weeks ago Buffalo Bills’ tight end Kevin Everett suffered a life-threatening spinal cord injury during a football game. Though his ultimate prognosis remains unknown, he has demonstrated some early neurological improvement that may be due at least in part to the rapid response of the emergency medical personnel and team physicians, including use of induced hypothermia which apparently had never been used this early in a human spinal cord injury. The ambulance/emergency medical technician team at the stadium had, in fact, met with team physicians Drs. John Marzo and Andrew Cappuccino a week before the first home game to go over procedures to be followed in the event of a suspected spinal injury. That training included the possible use of induced hypothermia by intravenous infusion of cold saline. The ambulance was also specially equipped with a backboard designed to accommodate a player's helmet and pads. At other NFL stadiums, physicians and emergency medical response teams simulated how they would respond to similar incidents.
Use of simulation in healthcare has become popular as a tool to help promote teamwork. Its roots are from Cockpit Resource Management training (also known as Crew Resource Management training) in the aviation industry (see our May 15, 2007 Tip of the Week). It’s most often used for teams, such as operating room teams, to improve communication skills and decision-making capabilities. Some simulators involve expensive hardware and software that allows life-like clinical situations and allows for “complications” or “unexpected circumstances” to be programmed into the simulation scenarios.
But simulation does not have to use expensive laboratories and equipment. Simulation could and should be part of your FMEA (Failure Mode and Effects Analysis) activities. Our September 11, 2007 Tip of the Week discussed the RCA on an unintentional chemotherapy overdose. Some of the issues addressed in the RCA dealt with the response and management of the patient after the patient had received the high dose of chemotherapy much more rapidly than planned. We wonder how many organizations that utilize such chemotherapy protocols (or a variety of other protocols, for that matter) have ever simulated such an unintended incident. Most often in a FMEA, one might simply note that someone would have to look up the effects of the chemotherapy toxicity and the clinical management of the patient. But an actual simulation in the above case may have surprised people when the paucity of published information on fluorouracil overdosage was discovered. Findings from such a simulation could certainly lead to a refinement of the protocol.
So a good simulation activity should include not only what steps are expected to be taken under certain circumstances but also anticipate what things might go wrong and how you would respond under those additional circumstances. Actually acting out the situation can sometimes produce surprises that lead to constructive changes. Think about adding that step when you do your next FMEA activity.