Public Release: 

LSUHSC innovation in patient safety training to improve surgical outcomes

Louisiana State University Health Sciences Center

New Orleans-On Wednesday, August 17, 2005 at 11:00 a.m. in the Isidore Cohn Learning Center on the campus of Louisiana State University (LSU) Health Sciences Center in New Orleans, a surgical team comprising surgery residents, anesthesiologists, circulating nurses, nurse anesthesia students, and medical students, will be thrown into a scenario where their patient develops a potentially fatal cardiac arrhythmia during a gallbladder operation. Other crises may occur as well, depending upon how the surgical team performs. Through a peerless combination and adaptation of the most sophisticated medical simulation and virtual technology developed to date, faculty at LSU Health Sciences Center (LSUHSC) in New Orleans are now training future generations of medical professionals to anticipate and avoid medical errors. To our knowledge, there is not another set-up like it anywhere in the United States. While other universities are using simulators and still others are doing mock training exercises, there is not another program that has connected independent technologies to relate laparoscopic surgery to a "live patient" in an environment with the look, feel, and function of a real minimally invasive operating theater.

Through industry partnerships, LSUHSC faculty have equipped a minimally invasive operating room with new-era lights, monitors, and cameras, and a fully responsive human patient simulator that faculty program to physiologically respond just like a patient undergoing surgery performed with a virtual reality laparoscopic surgery simulator. A quad split screen monitor displaying the OR activity, vital signs, the surgical field, and the scenario allows not only the surgical team to check information, but those immediately outside the virtual OR as well those in a large adjacent conferencing facility can monitor and also learn from the case.

Satellite capability will permit broadcast to remote locations as well.

Taking off on the airline industry's concept of crew resource training, the program at LSU Health Sciences Center in New Orleans' School of Medicine was developed by faculty surgeons, anesthesiologists, and curriculum specialists, and a second-year medical student who is a former commercial airline pilot. The training is so realistic that teams tend to forget that they're in a virtual environment. The goal is to sharpen team performance and optimize patient outcomes through improved communication and situational awareness, team interaction, and the identification and mitigation of system weaknesses, before lives are on the line. As with aviation, the rationale is that one of the best ways to promote and maintain safety is effective error-management training programs, and the LSUHSC program is currently unmatched in capability. Already, pilot sessions have demonstrated that such simple things as the positioning of monitors can have a tremendous impact upon team performance-a lesson which will have immediate application in LSUHSC hospitals.

The human patient simulator is a key component of the program. As its chest rises and falls with each breath, eyes blink, blood flows, heart beats, the simulator also produces urine and has the capacity to speak. It accurately mirrors human responses to such procedures as intubation, CPR, injection of medications, ventilation and catheterization. This complex mannequin is driven by medical gases, electricity, and computer software. In order to enlarge and improve the body of training scenarios, LSUHSC faculty created next generation software programs that overlay the existing programs, providing much more realistic and robust training scenarios. LSU Health Sciences Center filed a patent on this intellectual property and the patent is pending.

A training session begins as the surgical team is oriented to the virtual OR and briefed on the patient's case. They then perform the surgery. What happens to the patient is primarily dependent upon the actions or inactions of the team. Faculty may, however, introduce an interoperative event at any time during the procedure. Following the case, the team undergoes a thorough debriefing.

The nation's attention turned to patient safety with the release of an Institute of Medicine's To Err is Human: Building a Safer Health System report in November of 1999 that revealed that between 44,000 and 98,000 people die in hospitals each year as a result of medical errors that could have been prevented. The Joint Commission on Accreditation of Healthcare Organizations which has long focused efforts to improve patient safety, joined other organizations such as the American Medical Association in lauding the passage of the Patient Safety and Quality Improvement Act of 2005, passed by Congress and signed by President Bush on July 29th.

Through its innovative use of technology, development of improvements to that technology, and unparalleled training initiative, LSU Health Sciences Center in New Orleans' School of Medicine is now positioned as a national leader in patient safety training.


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