PURPOSE: The creation of an Interventional Pulmonology program at a large academic medical center involves changing paradigms for the institution as well as the providers who have been caring for patients in the operating rooms. Prior to performing the first case on real patients with complex airways our goal was to prospectively identify and eliminate potential risks. We hypothesized that simulating these new procedures and using tools from Lean Six Sigma (LSS) methodology could prospectively identify anesthesia, nursing and equipment issues that would directly impact patient safety.
METHODS: Two simulations of typical interventional pulmonology procedures were conducted in a operating room using a realistic patient simulator (SimMan®, Laerdal, NY). Each simulation modeled different scenarios including difficult intubation, hypoxemia, and tension pneumothorax. Each scenario necessitated a team response requiring communication between the operator, the anesthesia team as well as nursing and equipment staff. After the first simulation, a Failure Mode and Effects Analysis (FMEA) was conducted using LSS methodology to determine the severity, expected frequency, and ease of detection of defects. The identified defects were prioritized and corrected before the second simulation was performed.
RESULTS: The first simulation and subsequent FMEA identified and prioritized 18 potential defects: 4 related to patient safety issues, 6 to teamwork and communication, and 8 to equipment and supplies. These defects were addressed individually, and the revisions were validated during the second simulation. A multidisciplinary safety check system with cross-disciplinary accountability was developed and formalized as a patient-care protocol to be used with each interventional pulmonolgoy procedure. During the subsequent 42 rigid bronchoscopies equipment and supply defects were seen in three cases, with no occurrences of patient safety of communication defects.
CONCLUSION: A patient simulator was successfully used in conjunction with FMEA to prospectively detect and correct defects in patient safety, communication and equipment issues prior to the development of an academic interventional pulmonology program.
CLINICAL IMPLICATIONS: Patient simulation and the prospective identification of systems deficits may significantly reduce complication rates and “near misses.”
DISCLOSURE: David Feller-Kopman, No Financial Disclosure Information; No Product/Research Disclosure Information