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You are here: MEDICA Portal. Magazine & More. MEDICA Magazine. Topic of the Month. Volume archives. Our Topics in 2010. March 2010: Malpractice and Patient Safety. Communication.

Communication Was Successful, Patient Is Alive

Communication Was Successful, Patient Is Alive

Photo: Six empty speech bubbles

They look more and more like real humans: They have a pulse, a palpable heart-beat, audible respiration. They can perspire and bleed and they even have a voice with the help of a microphone. Simulation dummies are technically very well developed and can simulate many different diseases anywhere from Asthma to a heart attack. Those fascinating technical details help to demonstrate an emergency situation which almost seems real. Medical teams can practice team work on simulation dummies – without endangering a patient like in a real operation room.

“70 percent of mistakes can be traced back to so-called human factors“, explains Psychologist Peter Dieckmann from the Danish Institute for Medical Simulation (DIMS). This refers specifically to communication and coordination skills within a team environment- skills which medical students will not be able to learn in a lecturing hall. In Denmark, anesthesiologist interns need to train 16 days with simulation dummies during their residency training.

Silence is cheap, talk is golden

“Where is the blood I just ordered?“ The surgeon sounds irritated, since the patient on his operating table urgently needs a blood transfusion. “You ordered some blood?“ is the anxious response. Due to all the stress and acute concentration, the order was missed. Nobody on the team got blood bottles.

“Scenes like that come up time and again during simulation training“, reports Dieckmann. The team, which acts the same way it would in a real emergency and does everything to help the suffering dummy, can review their medical response practice on videotape. “For many this is a big epiphany“, according to Psychologist Theo Wehner from the Center for Organizational Ergonomics in Zurich, Switzerland. “Some people do not say anything during the entire medical response."

Photo: Physicians training with a simulation dummy
The practicing doctors have to do everything to "safe" the simulation dummy; © SAFER

Talk in the operating room should be kept to a minimum of course to keep the concentration going. Nevertheless, a few words at the right moment can save lives. Dieckmann explains that “it is important to close the communication loop. If somebody issues a directive, another person should give a clear response and confirm who is going to handle it.“ Otherwise, it remains unclear whether one, three or possibly nobody is taking care of it. “Pilots have had communication guidelines for some time“, says Dieckmann. “If someone gives the order to gain height, the second person orally confirms the execution of the order.“

Often team members are overwhelmed with a chain of orders: “I need this and that and the other - with monster sentences like that in the middle of a stressful situation, you run the risk of forgetting some orders“, says Dieckmann. What is more, is that it remains unclear in which sequence the instruments are needed. In real life this presents a risk for the patient on the operating table.

Learning from mistakes is made possible

Aside from risk-free team training, simulation dummies offer a second big advantage. Since all mistakes that are made remain harmless, they create an “error-tolerant setting“, according to Wehner: “That’s exactly what medical science needs to remove the stigma of making mistakes.“ After practice on the dummies, the performance of all team members is jointly discussed. Each crew member makes similar mistakes. This clearly shows all parties involved: Making mistakes is normal, and it can be best avoided by talking about them. This is a departure from the “Demigod in white“ and the demand of having to be infallible, which doctors place on themselves - a very important step toward patient safety.

There is a downside to this: So far anesthesiologists are leading the way. In other medical sectors, team training with the stoical, but expensive patient substitutes is not widely used. As a consequence, communication between different medical professions is rarely practiced: “Often a crew of anesthesiologists are training together“, explains Wehner. Someone plays the surgeon. Meanwhile the communication between surgeon and anesthesiologist as well as between surgeon and nursing staff is extremely important for the well being of the patient. “Interdisciplinary training needs to be become more frequent“, is Dieckmann’s wish for the future. “In the best case scenario, the training group should have the same composition it has in a real operating room.“

Anke Barth

(Translated by Elena O'Meara)


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