Why do Simulations?
Health care is rapidly evolving. Technical expertise, excellent communication and teamwork skills are necessary if we are to successfully care for our patients in a complex clinical environment.
In the Institute of Medicine's (IOM) 1999 report, teamwork and communication failures were identified as primary causes of medical errors. The aviation industry expierenced similar problems: poor communication, authority gradients and systems issues contributed to the majority of airline disasters. Aviation began to address these problems by correcting systems issues and deliberate simulation based practice of high risk but infrequent events like engine failure, fires, etc. In the last decade, health care has started to adopt simulation based training as a method to improve reliability, teamwork and communication. Current patient simulators are capable of exchanging real gases (oxygen, carbon dioxide and nitrogen,), producing palpable pulses, audible heart sounds and respiratory sounds, as well as other physiologic cues like pupillary responses and EKG waveforms. Patient simulators allow for real-time interventions such as defibrillation and medication administration.
The IOM report advocated that health care training incorporate "proven methods of teamwork training like simulation". This report also recognized the importance of breaking down "silos;" it is important to train as we work. Instead of nurses practicing with nurses and doctors practicing with doctors, we should train as multidisciplinary teams -- physicians, nurses, respiratory therapists -- working together just as we work in the clinical environment.
In patient safety training, we learn "technical skills" (or algorithms of care), but equally important, we also practice "non-technical skills (teamwork and communication tools). This has shown great promise in helping health care providers to function more effectively and safely in the clinical environment. Simulation gives us the ability to practice these skills in a safe environment. The simulated experience provides a realistic and challenging experience that prepares the health care team to perform successfully in the clinical setting.
Simulation provides a safe method to improve proficiency, communication and teamwork skills and improve the quality and safety of the care we deliver to our patients.
