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VA NY Harbor Health Care System


Making patients safer

Emergency medicine physician Lisa Nocera, M.D

Emergency medicine physician Lisa Nocera, M.D

Thursday, February 23, 2012
Emergency medicine physician Lisa Nocera, M.D., is thrilled that her interest in bringing medical simulation team training to her emergency department engaged the interest of the VA’s National Center for Patient Safety (NCPS), based in Ann Arbor, Michigan. The VA’s top trainers will arrive at VA’s Manhattan campus on March 7 to launch an 18-month focus on enhancing patient safety in the Emergency Department (ED) through better teamwork and communication.

Medical Team Training (MTT) begins for the emergency department at the VA’s Manhattan campus with trainers from the National Center, Physician Educator Lisa Mazzia, M.D., and Nurse Educator Lori DeLeeuw, R.N. They will be joined by Robin Hemphill, M.D., VHA Deputy Chief Patient Safety Officer and NCPS Director. As an emergency room physician, Dr. Hemphill has a particular interest in bringing MTT and simulation to the ED.

Together they will facilitate an intensive two-day training for the entire emergency department staff, including ED doctors, nurses, psychiatrist, social worker, health care technicians, administrative support staff and housekeepers. The group from NCPS is bringing highly sophisticated, computer controlled, wireless simulation manikins designed especially for medical training. “It can cry, sweat, vomit, show rapid heartbeat and respiratory distress,” said Dr. Nocera.

The team training will consist of two identical morning interactive didactic sessions and two afternoons where the entire morning group participates in simulated scenarios involving medical crises such as cardiac and respiratory arrests. The purpose of the medical simulation is to create an engaging, challenging and safe learning environment where ED staff can practice the team-building strategies and tools taught during the morning sessions and get feedback on how to optimize their performance. The emergency department also will implement a two critical team-building tools into their daily routine to help sustain their efforts. One is a mid-day huddle where the entire department comes together for quick bedside rounds to help strategize and develop shared care plans and goals. The training emphasizes the need for situational awareness of the environment and co-workers so that staff gain a heightened awareness of when a co-worker may require task assistance and be prepared to assist.

“The MTT program was designed to aid in the development of a culture of safety, a large part of which is the creation of high functioning medical team," Dr. Hemphill said. "It is well recognized that a lack of teamwork and communication among health care professionals harms patients. After several years of development and implementation, the MTT program has proven it is effective in improving teamwork and communication resulting in improved patient care and outcomes. Three studies published during the past two years support this, indicating outcomes such as a decrease in the number and severity of wrong site surgery and a decrease in surgery-related complications. We are excited to reinforce the communication tools and techniques introduced in the interactive didactic session by utilizing high fidelity simulators in real life scenarios. This allows staff to practice managing difficult situations in a safe setting. We create a blame-free environment where everyone is encouraged to speak up and help one another solve often difficult problems.”

The idea for MTT came from the realization that many safety issues in health care are related to a failure in communication. Communication failure is a leading source of adverse events in health care, according to the Joint Commission. “Insufficient communication” was the most frequently cited root cause of the nearly 3,000 sentinel events reported to the Joint Commission between 1995 and 2004; more than 70 percent of all OR-related sentinel events between 1995 and 2005 cited communication as a root cause. The aviation industry recognized this problem more than 25 years ago and developed Crew Resource Management (CRM) to address communication failure. CRM is defined as using all available sources (information, equipment, and people) to achieve safe and efficient operations. VHA implemented mandatory MTT trainings in 2007 focusing, on all Surgical Services and Intensive Care Unit (ICU) settings. In 2009, voluntary training sessions were added to areas such as cardiac catheterization labs, endoscopy units, and primary care clinics. Trainings specifically focused on improving emergency department communication with other departments or multiple services have already been held at four emergency departments throughout the U.S. (including Northport, VISN 3), but, “This is the first time an emergency department has reached out and asked us to come because they want to make improvements within their own setting, it’s very exciting,“ said Dr. Mazzia. One study published in “The Journal of the American Medical Association (JAMA), October 2010, “found an almost 50 percent greater decrease in the annual surgical mortality rate in groups trained in MTT methods, as opposed to untrained groups. It was also noted that the longer MTT had been practiced at a medical facility, the greater the decrease in mortality. Dr. Nocera said that similarly she anticipates that the impact of implementing the MTT approach on the quality of care delivered and overall patient safety in her emergency department will be studied and submitted for publication in the future.


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