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Emergent Thoracotomy Post Minimally Invasive Robotic Cardiac Surgery: Team Simulation Learning Experience FREE TO VIEW

Ntesi Asimi; Sugam Bhatnagar; Samata Paidy; Robert Poston
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University of Arizona Medical Center, Tucson, AZ

Chest. 2014;146(4_MeetingAbstracts):558A. doi:10.1378/chest.1992195
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SESSION TITLE: Patient Safety Initiative Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: The early adoption phase of robotic cardiac surgery is often characterized by suboptimal communication and poor organization among team members. There is no sternotomy with minimally invasive approach. This changes the routine for a “code blue”, thereby increasing the risk of an inefficient response and preventable patient harm. We hypothesized that exercises to simulate this high stress scenario would help improve technical and teamwork performance

METHODS: Over a period of thee months, we performed three exercises with simulated cardiac tamponade after robotic surgery progressing to cardiac arrest. The primary team included CT surgeon, surgical resident, anesthesiologist, registered nurses, and respiratory therapists. Each case was videotaped and involved didactic and debriefing sessions, and post-exercise survey of the participants. Two independent raters reviewed the videos and rated the experience based on time to response, recognition and intervention taken; code assembly; supplies availability, human factors and additional measures

RESULTS: Code diagnosis time, time to thoracotomy, and time to direct cardiac defibrillation time improved from 1.46min→0.55min, 15.22min→9.30min, and 18.40min→11.09min respectively. The completeness and organization of the thoracotomy tray and crash card were improved with each successive exercise. The first exercise was categorized by high incidence of communication errors, largely related to misunderstanding of individual roles, duties and leadership responsibilities. Those were addressed and improved following post-exercise debriefing session. Additionally, advanced closed loop communication skills were utilized at later sessions

CONCLUSIONS: Robotic cardiac surgery poses a multifactorial array of challenges. One proven approach to improving outcomes has been the use of the multidisciplinary cardiac team. We expanded on this concept by using simulation to develop and implement a new protocol for efficiently managing cardiac arrest out-of-the-operating room. In high volume academic medical center such as ours where approximately a third of cardiac cases are performed minimally invasively, efforts to improve teamwork efficiency using simulation seem likely to improve safety during this early, high risk period

CLINICAL IMPLICATIONS: Our limited experience suggests that team simulation contributes to building of a well organized and functioning multidisciplinary team, improves team communications and performance likely translating into safer practice and better outcomes.

DISCLOSURE: The following authors have nothing to disclose: Ntesi Asimi, Sugam Bhatnagar, Samata Paidy, Robert Poston

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