Standardized Simulated Events for Provocative Testing of Medical Care System Rescue Capabilities

Excerpt

Background: Human errors that result in rare critical events during the course of routine medical care are especially difficult to study. Although the incidence of severe respiratory depression with routine sedation is small, millions of patients receive this care annually, putting hundreds or thousands of persons at risk. Elimination of sedation errors is particularly important since associated deaths and neurological injuries are virtually 100 percent avoidable.Objectives: The researchers tested the feasibility and validity of using a commercial human simulator to probe care systems for system vulnerabilities (“accidents waiting to happen”).Methods: The study required (1) development and validation of a simulated rare event, (2) use of the standardized event to test care systems in context, and (3) video analysis for deviations in observed care relative to gold-standard care. Scenario: The standard event was reproducible, with physiology that degraded over time if no interventions occurred, and improved when treated appropriately. “Crash-testing” actual care domains: Team performance in managing the simulated event was videotaped and data files of the simulator's physiology variables were captured.Analysis: The quality of each team's performance was assessed using the simulator data files to calculate “time-out-of-range” measures for the critical variables, and team behaviors were analyzed for deviations from idealized care.Results: Available technology supports the creation of a sedation critical event that is realistic, reproducible, and portable. The simulator-based provocative test readily allowed comparison of rescue performance in different sedation care settings (e.g., emergency room, radiology department) to be contrasted with a gold standard.Conclusion: This research supports the feasibility of using available human simulation as a “crash-test dummy,” capable of measuring the rescue systems used in a variety of actual sedation care settings. The findings demonstrate that personnel deemed competent and safe, on the basis of meeting hospital training requirements for airway management, had profound performance deviations when compared to gold-standard practice.