Friday, March 12, 2021

A Great Example of How Team Training Using Simulation Improves Outcomes and adds Joy

Healthcare is a high-risk industry – just like commercial aviation and nuclear power. Unlike these other two high-risk endeavors, healthcare has only recently learned the importance of training as a team in a controlled, safe environment. 

When I was a resident physician a few decades ago, the adage was “see one, do one, teach one.” I was involved in many high-risk events like resuscitating a newborn baby or doing a total volume blood exchange on a sick premature infant. Generally, I was allowed to do these procedures without supervision after seeing one of them done. The notion that I should train to do the procedures with the teammates who would be assisting me was a foreign concept. There was very little discussion about the risks to the patients of having a relative novice do the procedure. It was assumed that I knew what I was doing and that I would be vigilant. 

I am so glad that things are not like that anymore. Healthcare now understands what commercial aviation has known for decades. When lives are at stake, competency and readiness cannot be taken for granted. In addition, we now recognize that no one person can do everything and that no one is perfect. We need teams! At GBMC, we are blessed to have a state-of-the-art Simulation Center – just like pilots and co-pilots train in – so that individuals and teams can practice. This way, when the time comes, they are ready. Every procedure has risk, and we want to know that what should happen, happens, and what should not happen, doesn’t. This is the definition of high reliability. 

Recently, I was told a story that made me very proud and underlined just how far we have come in our quest for the highest level of patient safety and high reliability. 

A few weeks ago, we had a very busy day in our intensive care units. The units were close to full capacity as we had an influx of patients from our Rapid Response Team (RRT). One of these patients had a very low heart rate at 60 beats per minute and was going in and out of consciousness. During the three second pauses between beats, the patient’s eyes would roll back, and he would become unresponsive.

David Vitberg, MD, our Director of the Division of Medical and Surgical Critical Care, along with ICU nurses Michelle Braun, Lauren Walsh, Erin Saunders, and Mike Porter, jumped into action. With the support of his team, Dr. Vitberg inserted a sheath and transvenous pacer. Within a few minutes everything was complete. The pacer wire was in, the patient was being paced at 70 beats per minute, and thereafter he remained completely stable. The team was elated. They had smoothly and effectively performed a life-saving procedure. It was a procedure that they do very infrequently, but because they had trained to do this in the simulation lab as a team, it went off without a hitch. 

Dr. Vitberg told me that “It was spontaneous, authentic, mutual happiness for our patient and our team. The success of saving a man’s life felt great! We all knew something special had happened and we all knew "why.

This man is still living today in large part due to the interdisciplinary simulation training where Dr. Vitberg and his ICU team practiced the insertion of a transvenous pacer. 

I’m so proud of these ICU colleagues for their teamwork and I am grateful to our leaders Dr. Vitberg and Nurse Manager, Rachel Ridgely, RN, and to Deborah Higgins, RN, MS, Manager of the Simulation Center, and to Dr. Donald Slack, Director of Medical Education of the Simulation Center, for seeing to it that training happens and that team learning is achieved. 

Turning blue to raise awareness
You may have noticed the blue wall lighting coming down the concourse from the Lily Garage into the hospital and a shade of blue shining on our main sign on Charles Street. This was done, in conjunction with the American Cancer Society (ACS), Colon Cancer Coalition and Fight Colon Cancer, to shine a bright light in recognition of Colorectal Cancer Awareness Month to support patients, increase awareness, raise screening rates, and save lives. 

Colorectal cancer is the second leading cause of cancer death in the United States and the third most commonly diagnosed cancer in both men and women. Unfortunately, ACS statistics show that due to COVID-19, colonoscopies declined nearly 90 percent in April 2020 from the previous year, which could result in an additional 4,500 deaths from colorectal cancer in the next 10 years. If you are due for one, please make sure that you schedule your colonoscopy as soon as possible Colon cancer is one of the few cancers that can be prevented through timely screening and removal of pre-cancerous polyps.

I want to thank Brian Fitzpatrick, our Energy and Facilities Manager, and his crew for their work in turning our lights blue. I hope it encourages people to get screened when they are due!

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