by Scott J. Turner
(Originally published in Brown University's George Street Journal, October 18, 2002)
A new patient at Rhode Island Hospital gets sick no matter how good the treatment. The patient is a computer-controlled, anatomically correct rubberized manikin. It presents medical teams with all of the vital signs, including pupils that react to light, and lung and heart sounds. This patient even groans.
The manikin is the centerpiece of the new Rhode Island Hospital Simulation Center. The state-of-the-art facility hopes to help medical professionals and those still in training learn to minimize the possibilities of medical error.
The facility aids "our effort to teach individuals to work together with maximum effectiveness," said director Marc Shapiro, MD, assistant professor of medicine. "The primary goal of the center is to improve interdisciplinary team performance. People who function in teams need to be trained as teams."
The center is a 3,000-square-foot replica of an emergency department, with bays that transform into an operating room, critical-care setting or ambulance interior. Behind a wall of one-way mirrors are observers and an audio-visual room housing the manikin controls.
Medical teams began training in the center in late September. After an exercise, a team and its mentors study videotape of the simulated emergency. Evaluation focuses on roles and responsibilities, problem solving, communications, workload distribution and human factors.
"You want to pick up early what is going on in the team," said Robert Woolard, MD." You want to learn from any mistakes as soon as possible." Woolard is chief of emergency medicine at Lifespan and chair of the Medical School's section of emergency medicine.
The simulation center grew out of research and training begun in 1996 by Gregory Jay, MD, assistant professor of medicine. Jay formed teams of a physician, nurse, respiratory therapist, and medical resident - each with advanced skills in emergency medicine - who worked and thought as a unit. The center took shape in response to the landmark 1999 report by the Institute of Medicine that linked medical errors to the deaths of more than 44,000 hospitalized Americans each year. A startup grant from the Champlin Foundation plus major support from Rhode Island Hospital financed the effort.
"The key to avoiding errors and improving safety is a team approach, which is best practiced in a simulator," said Joseph Amaral, MD, president and CEO of Rhode Island Hospital and a professor of surgery. "This was first learned in other critical industries like flight operations and military maneuvers."
Shapiro hopes to add four more manikins, including a pediatric model, so that the teams "get practical experience working in an emergency arena caring for multiple patients," he said.
"Clearly there are applications to other departments such as anesthesia or critical care-any practice where a medical team gathers," said Woolard. "The ultimate goal is to maintain the highest standards of patient safety."