Reducing Errors

The 1999 Institute of Medicine (IOM) report, "To Err is Human," brought national attention to medical error and specifically recommended the use of simulation to support human factors training.

From airplanes to the bedside

Simulated patient care experience is an idea adapted from airline industry flight simulators, which have been used in pilot training for more than 50 years. Aviation has provided clear evidence for the contribution of individual and team errors to the occurrence of crashes and near misses. As a result of these studies, Crew Resource Management (CRM) curriculum for team training, supported by realistic flight simulators, is an annual mandatory training standard in the aviation industry.

This pioneering work served as a model for the Anesthesia Crisis Resource Management course, which was one of the first applications of high fidelity medical simulation in medicine.

Medical simulation reduces errors at local hospitals

Locally, Rhode Island Hospital and its Hasbro Children's Hospital have been funded participants in a U.S. Department of Defense project, MedTeams, to transfer lessons learned in army aviation to medical teams in the Andrew F. Anderson Emergency Center.

This multi-center military and civilian project demonstrated the benefits of implementing a teamwork training curriculum in emergency medicine:

• Clinical error rate decreased from 30.9% to 4.4% in the experimental group.
• ED staff attitudes toward teamwork improved.
• Staff assessments of institutional support showed a significant increase.

As with the aviation experience, sustaining improved performance requires ongoing training, and this concept has contributed to the development of high fidelity medical simulation at Rhode Island Hospital.

With support from Rhode Island Hospital, the Champlin Foundation, and the MedTeams project, the Rhode Island Hospital Medical Simulation Center began operation in May 2002.