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February 1, 2016
The operating team is finishing a pulmonary resection for lung cancer. The surgery has gone well. Until, the patient shows signs of distress and quickly descends into respiratory arrest. The cause for the moment is not known. The thoracic surgeon, nurses, and respiratory therapists rely on their training and quick reflexes to establish the cause and save the patient. Some immediately begin to act, others wait for instruction. The life-saving procedure is finished. The operating room team gathers and begins to discuss the events that just transpired while the patient, a CPR mannequin, lies inanimately on the operating room table awaiting the next procedure, and emergency.
This in situ, or on-site, simulation scenario occurred in the operating room with the participation of thoracic surgeons, operating room nurses, respiratory therapists, and residents. This scenario, repeated throughout the day, marked the successful launch of London Health Sciences Centre’s (LHSC) Thoracic Surgery simulation program—the first of its kind in Canada.
“These simulated surgeries promote teamwork, help to identify areas needing improvement, and provide an unparalleled learning opportunity for surgical trainees. Ultimately, this type of exercise will lead to more efficient operating room procedures, thereby enhancing patient care,” says Richard Malthaner, Thoracic Surgeon, LHSC.
The simulation day was facilitated by Dr. Rob Leeper, Trauma Surgeon and Simulation Expert, London Health Sciences Centre and Department of Surgery at Western University. The participants were randomly assigned into three groups – each including a surgeon, anesthesiologist, and two nurses. Each scenario, audio and video recorded, was followed by debrief that lasted nearly as long as the scenario itself. “Simulation is the next frontier in medical education and procedure improvement,” he says. “The program tests the core competencies of participants, but also challenges them during a high-risk lifesaving scenario which has previously occurred.”
The simulation session did not require any equipment outside of what was already present in the operating room, and a CPR mannequin. “Our cost-effective scenario was developed by our international simulation research fellow Dr. Eustatiu Memu from Romania and our summer research student Joel Bierer from the Schulich School of Medicine & Dentistry at Western University,” says Dr. Richard Malthaner.
“The key to these simulation exercises is realism, and sometimes that means only using as high of fidelity as you require,” adds Dr. Leeper. “This is especially true in resource constrained environments. It can be done.” In a safe environment, participants are able to practice their individual skills, work on team building, and look for areas of improvement in their work environment. “What was evident as we ran our scenarios was the importance of a highly skilled nursing team. Their immediate actions and teamwork lead to better patient outcomes.”
Dan Romano, Registered Nurse, Perioperative Care, LHSC, whom like everyone else, donated his time on a Sunday, felt better prepared having practiced for a potentially real and probable situation. “It was an amazing experience. All of us, no matter our experience level, were able to improve ourselves, but also our work processes.”
The early results of the simulation noted a redundancy in the packaging of certain materials, recommended changes to the way some operating tools are stored, a the requirement for common knowledge of where some of the rarely used equipment is kept.
“By building a consistent and experienced team, well-rehearsed in life-saving maneuvers and possessing vital communication skills, the delivery of critical services to our patients will become more effective and efficient than ever before,” emphasizes Dr. Malthaner.