Human Patient Simulators Help Reduce Medical Errors
Jan 02, 2018 12:56PM ● Published by Emily Stevenson
Professor, Director of Human Patient Simulation - STAT Center
Simulation Technologies and Training Center, Greenville Technical College
First time parents at a rural hospital are told that their baby is in distress as the umbilical cord is wrapped around her neck, causing restricted blood flow to the fetus. Fortunately, the labor and delivery nurse has been trained for this type of emergency and has performed the necessary procedure under the watchful eye of an experienced instructor.
The medical helicopter flight crew arrives at the scene of a horrible automobile crash and finds the 23-year-old patient with a crushed trachea. They must perform the emergency tracheotomy within the next few moments or he will die. They have seen this type of critical life-threatening emergency in a controlled setting and have successfully performed this procedure numerous times.
New clinicians are at a disadvantage when dealing with critical patients and situations, as they have not had the time to gain valuable experience. So how can they be prepared for the high acuity patients they may encounter? School and “book knowledge” are no longer enough in the fast-paced medical field.
A study performed in 1999 entitled “To Err is Human: Building a Safer Health System” estimated that between 44,000 and 98,000 people died in the United States every year due to medical errors. Reasons for these errors included lack of or inefficient educational practices.
This study was a driving force for the creation of human patient simulators and the use of hands-on patient simulation training as part of initial and ongoing medical training and education. Around the same time, sophisticated mannequins were being developed and started becoming popular in health care training. Unlike early models that were called “dummies” and were used primarily for CPR practice, these simulators could cost as much as $250,000.
Early models were fashioned after adults and had minimal features such as active breathing, few pulses, cardiac rhythm monitoring, and airways that could have invasive devices inserted. With advances in technology, these simulators now have the capability of producing hundreds of cardiac rhythm variations, 12 lead EKGs, various lung sounds, heart tones, bowel sounds, pulses throughout the body, active blood pressure monitoring, pupillary responses, and seizures. Other models can sweat, cry, urinate and bleed. There are now simulators for childbirth that have palpable contractions and can reproduce problematic births such as nuchal cord, shoulder dystocia, limb presentation and breech deliveries as well as post-partum hemorrhage. Infant and child simulators are available, giving educational facilities the option of having simulators ranging in age from newborn through adults.
Greenville Technical College opened a patient simulation center for health science students in June 2009. The STAT Center (Simulation Technologies and Training Center) is home to 10 high fidelity mannequins: three neonates, two children, and five adults, including a dedicated birthing simulator. There are also high-tech CPR mannequins that give objective feedback as to the efficacy of skills performed by the learner.
The simulators are used across all health programs, with students in the respiratory therapy, nursing, radiology, occupational and physical therapy, dental assisting and hygiene, and EMT/paramedic programs benefitting. To date, 1,582 classes have been hosted, 27,353 students have visited, and 76,485 simulated patient contacts have taken place. Lucy, the birthing simulator, has delivered more than 250 times.
Unfortunately, since “To Err is Human” was published in 1999, the number of medical error deaths has not decreased. In fact, the number of deaths has increased to an estimated 250,000 every year due to preventable medical errors. Many causes have been suggested by various sources for the increase including a need for better teamwork and greater standardization in the way patients are treated. While educators can’t control these issues, we can make sure that we continue to use human patient simulation as one of the most effective tools in creating a competent medical workforce.
Human patient simulators continue to increase in sophistication, boosting the effectiveness of these teaching tools. Technology now entering the simulation market includes an augmented reality version ultrasound simulator, which incorporates a Microsoft HoloLens module so the student can display different body parts and anatomical structures as a holographic 3D image. The user can enlarge, turn, and rotate realistic-looking anatomical parts or return them into the holographic mannequin body. Other options available are transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), general abdominal ultrasound, lung ultrasound, and obstetric and gynecologic ultrasound.
Another vendor is offering a mannequin with common features such as breath sounds, pulses, spontaneous respirations, and CPR feedback. This model also comes with a 3D printer and CAD architecture and software so you can “custom design elements of the mannequin yourself, such as a traumatic amputation or a new arm.”
Simulation has played a strong role in allowing health care providers to practice in a safe environment. As the tools advance, the experience provided should become more valuable. This will ensure that those entering the health care field and receiving ongoing education have the tools needed to approach even unusual situations with confidence.