Simulation-Based Trial of Surgical-Crisis Checklists
ABSTRACT Operating-room crises (e.g., cardiac arrest and massive hemorrhage) are common events in large hospitals but can be rare for individual clinicians. Successful management is difficult and complex. We sought to evaluate a tool to improve adherence to evidence-based best practices during such events.
Operating-room teams from three institutions (one academic medical center and two community hospitals) participated in a series of surgical-crisis scenarios in a simulated operating room. Each team was randomly assigned to manage half the scenarios with a set of crisis checklists and the remaining scenarios from memory alone. The primary outcome measure was failure to adhere to critical processes of care. Participants were also surveyed regarding their perceptions of the usefulness and clinical relevance of the checklists.
A total of 17 operating-room teams participated in 106 simulated surgical-crisis scenarios. Failure to adhere to lifesaving processes of care was less common during simulations when checklists were available (6% of steps missed when checklists were available vs. 23% when they were unavailable, P<0.001). The results were similar in a multivariate model that accounted for clustering within teams, with adjustment for institution, scenario, and learning and fatigue effects (adjusted relative risk, 0.28; 95% confidence interval, 0.18 to 0.42; P<0.001). Every team performed better when the crisis checklists were available than when they were not. A total of 97% of the participants reported that if one of these crises occurred while they were undergoing an operation, they would want the checklist used.
In a high-fidelity simulation study, checklist use was associated with significant improvement in the management of operating-room crises. These findings suggest that checklists for use during operating-room crises have the potential to improve surgical care. (Funded by the Agency for Healthcare Research and Quality.).
- SourceAvailable from: Jan Breckwoldt
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- "Simulations were successfully used as a research tool to evaluate variations in the retention of knowledge and skills over time (Smith et al. 2008 ), in the appropriate time intervals for refresher trainings (Woollard et al. 2006 ), and in alternative training devices to enhance retention (Spooner et al. 2007 ). Arriaga et al. ( 2013 ) investigated operating room teams working in a series of surgical crisis scenarios in a simulated operating room. Each team was randomly assigned to manage half the scenarios with a set of crisis checklists and the remaining scenarios from memory alone. "
ABSTRACT: An overview is presented of the strengths and limitations of simulation learning, with a particular focus on simulation learning in medicine and health care. We present what simulation learning is about and what the main components of simulations are. The most important theoretical approaches are reviewed which were developed in order to explain why simulation learning is effective. The most prominent best-practice examples of simulation learning applications are presented, and a short overview on research fi ndings concerning simulation learning is given.International Handbook of Research in Professional and Practice-based Learning, Edited by S. Billett, C. Harteis, H. Gruber, 01/2014: chapter Simulation learning: pages 673-98; Springer, Heidelberg., ISBN: 978-94-017-8901-1
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- "By adopting a systematic framework, the extraneous load of checking can be reduced, allowing trainees to focus on finding mistakes. Often, these frameworks are organized into checklists , which have helped physicians reduce error in a variety of contexts (Wolff et al. 2004; Haynes et al. 2009; Winters et al. 2009; Ely et al. 2011; Arriaga et al. 2013; Sibbald et al. 2013). Many checklists focus on the key variables involved in a diagnostic or management decision (Hales et al. 2008). "
ABSTRACT: Background: Checking diagnostic and management decisions can help reduce medical error, however, little literature explores how this is best taught. Aims: To provide practical advice to direct teaching practices. Methods: The authors conducted a literature review using Medline and PsychInfo using search terms: check or checklist and medical error or diagnostic error, supplemented by a manual search through cited literature. Conclusion: Twelve tips for teaching how to check diagnostic and management decisions are presented.Medical Teacher 11/2013; 36(2). DOI:10.3109/0142159X.2013.847910 · 2.05 Impact Factor
Article: Making a List and Saving a Life.[Show abstract] [Hide abstract]
ABSTRACT: Checklists reduce the failure rate of lifesaving procedures during operating room crises.The American journal of nursing 04/2013; 113(4):15. DOI:10.1097/01.NAJ.0000428728.16148.b4 · 1.32 Impact Factor