Health Care Providers Training on Human Patient Simulators to Reduce Medical Errors in Emergency Departments

Cincinnati Children's Receives $243,000 Federal Grant

Tuesday, September 20, 2005

CINCINNATI -- Cincinnati Children's Hospital Medical Center is training health care providers using human patient simulators to reduce medical errors in the emergency department -- an area of hospitals that the Institute of Medicine has identified as having a high risk of adverse events.

With the help of a two-year, $243,000 grant from the Agency for Healthcare Research and Quality, Cincinnati Children's is conducting situation-based safety training, based on principles borrowed from aviation and other high-risk industries. The simulations mirror the kinds of situations often encountered in an emergency medical setting.

"We set-up the kinds of chaotic situations that we see in real life," says Mary Patterson, MD, an emergency physician at Cincinnati Children's and principal investigator of the grant. "This forces medical providers to practice behaviors that will be safer when they encounter these situations in reality. As many as three of every four adverse events that occur in emergency departments are due to communication issues among providers."

The training emphasizes team behaviors -- not only to decrease errors but also to quickly identify those that do occur and to mitigate their effects, according to Dr. Patterson. For example, instructors introduce deliberate errors; create situations in which appropriate care is ambiguous, making conflict among caregivers likely; and bring in people posing as parents to distract the team while it is providing simulated care.

"There are times when someone in higher authority is not doing the right thing. They may not have all the information or they may have had a momentary lapse," says Dr. Patterson. "When people of varying positions and authority work together, as they do in the emergency department, those considered in lower positions may not be comfortable challenging those of higher authority. If they don't, something bad can happen. This training is intended to eliminate these kinds of issues."

Cincinnati Children's has two patient simulators, one a child and one an adult. The medical center is adding a newly designed infant simulator and a second adult simulator, this one equipped for bioterrorism simulation. In the next 18 months, physicians, nurses, residents, patient care assistants and emergency medical squads will each spend a day and a half together in training. The multidisciplinary nature of the training is unique in that "every emergency provider who touches a patient" will go through the curriculum, according to Dr. Patterson.

"The program has been a vital part of my pediatric emergency medicine training," says Hamilton Schwartz, a fellow in emergency medicine. "It affects what I do almost every shift I work and has improved my delivery of care. This program could easily be adapted to other pediatric hospitals and to adult hospitals as well. Its focus isn't pediatrics; it's communication among team members in an emergency situation."

Whether the training actually reduces medical errors will be difficult to measure. But the evaluation of the program will include examining behaviors during real traumas to ensure that what's learned in training is transferred to the real world. If it's successful, it could change the way educators approach patient-safety training, according to Dr. Patterson.

"I think we have an opportunity to make training more realistic; based more on the way adults actually learn," she says. "Instead of sitting in a classroom, we're having people actually practice behaviors. I think that's a quantum leap in the way we approach patient safety. I think it's the wave of the future."

Cincinnati Children's is a 423-bed institution devoted to bringing the world the joy of healthier kids. Cincinnati Children's is dedicated to transforming the way health care is delivered by providing care that is timely, efficient, effective, family-centered, equitable and safe. It ranks third nationally among all pediatric centers in research grants from the National Institutes of Health. The Cincinnati Children's vision is to be the leader in improving child health.