International Journal of Critical Illness and Injury Science

EXPERT COMMENTARY
Year
: 2020  |  Volume : 10  |  Issue : 1  |  Page : 4--8

Operating room trauma simulation: The St. Luke's University Health Network experience


Victoria Marcks1, Kathryn Hayes2, Stanislaw P Stawicki3,  
1 Department of Surgical Services, St. Luke's University Health Network, Bethlehem, Fountain Hill, Pennsylvania, USA
2 Department of Surgery, St. Luke's University Health Network, Bethlehem, Fountain Hill, Pennsylvania, USA
3 Department of Surgery; Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Fountain Hill, Pennsylvania, USA

Correspondence Address:
Dr. Stanislaw P Stawicki
Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, PA 18015, Fountain Hill, Pennsylvania
USA

Abstract




How to cite this article:
Marcks V, Hayes K, Stawicki SP. Operating room trauma simulation: The St. Luke's University Health Network experience.Int J Crit Illn Inj Sci 2020;10:4-8


How to cite this URL:
Marcks V, Hayes K, Stawicki SP. Operating room trauma simulation: The St. Luke's University Health Network experience. Int J Crit Illn Inj Sci [serial online] 2020 [cited 2020 Jun 1 ];10:4-8
Available from: http://www.ijciis.org/text.asp?2020/10/1/4/280227


Full Text



 Introduction



The maintenance of readiness is an important component of care optimization for the critically injured trauma patient. This applies to the individual, the team, and the system levels. Evidence shows that there may be a correlation between trauma volumes and effective trauma team readiness and that there may also exist a relationship between clinical outcomes and the number of patients treated during a specific period of time.[1] Simulated cases, especially those featuring realistic, high-fidelity scenarios, have the potential to materially enhance trauma team readiness, retention of process-specific skills, and knowledge, in addition to improving the critical thinking ability.[2],[3],[4],[5] To help enhance our trauma team's functional readiness in the emergency operative setting, we set out to design and implement an operating room (OR) trauma simulation (ORTS) exercise. The aim of this simulation exercise was to identify the key opportunities to further optimize our existing OR trauma procedures and performance.

 Operative Trauma Simulation Scenario



Case simulation summary

Level A Alert (e.g., highest acuity) is called for a trauma patient who presents after sustaining a gunshot wound to the abdomen. He is unstable, is promptly brought to the OR, and massive transfusion protocol is called due to rapidly deteriorating patient condition. The attending trauma surgeon then decides to prepare for emergency thoracotomy, including open cardiac massage and direct application of internal defibrillation pads. In the meanwhile, the patient responds to less invasive resuscitative maneuvers, the thoracotomy is aborted, and the surgeon proceeds with the original plan to perform an exploratory laparotomy.

The setting

The simulated case scenario took place at the University Hospital OR (St. Luke's University Hospital, Bethlehem, Pennsylvania, USA).

Key components and structure of the process

The overall ORTS process is simple but requires excellent operational integration due to ongoing primary OR activities. The overall exercise takes anywhere between 30 and 50 min, depending on the completion time for each of the preplanned phases [Figure 1]. The list of exercise participants, including their respective roles, is provided in [Table 1]. The ORTS is designed to evaluate the skills and system-based aspects specific to emergency OR trauma cases [Table 2]. Within this framework, each learner is exposed to predefined goals, objectives, and skills [Table 3]. A deliberate preparation process [Table 4] and simulation set-up process [Table 5] takes place before the exercise commences. The simulation itself is highly structured [Table 6] and incorporates a formal skills assessment grid, complete with postexercise debrief [Table 7]. Sample photos from the simulation exercise are provided in [Figure 2].{Figure 1}{Table 1}{Table 2}{Table 3}{Table 4}{Table 5}{Table 6}{Table 7}{Figure 2}

 Discussion



Simulation is one of the most important tools to achieve and maintain readiness in trauma scenarios, especially when dealing with the less commonly encountered patient who is in extremis. Among the cornerstones of effective trauma response is the right combination of team coordination, communication, and collaboration. Without these three components, an organized trauma response is bound to have inherent inefficiencies, and patient outcomes may suffer as a result.[6],[7],[8]

Barriers to implementing effective simulation include low fidelity/lack of realism, inadequate logistics, insufficient time, financial consequences of “nonproductive” time, intimidating or stressful environment, and fear of being judged/critiqued.[9] Of importance, without institutional commitment to high-quality simulation, critical processes used in emergent scenarios may suffer when put to the real-life test. Previous research suggests that lower-than-usual trauma volumes, even for very busy trauma centers that experience a “temporary slow-down,” may result in worse outcomes during such slower periods.[1] Consequently, fostering some form of “mission readiness” may be beneficial to ensure that appropriate levels of critical thinking and cognitive skills, along with technical competency, are maintained [Table 7].[10],[11],[12],[13]

Simulated scenarios, especially high-fidelity ones, promise to provide an effective platform for the maintenance of readiness, especially in the context immediately relevant to this commentary.[10],[11],[13],[14] In addition, simulation-based training may also be beneficial in provider confidence building and patient safety promotion.[13],[15],[16],[17] These concepts take on further significance and depth when considered in the inter-professional environment of modern trauma practice, where large and intricately interconnected teams are required to perform highly coordinated, complex task sequences in patient-centered fashion.[18],[19],[20]

In conclusion, the current report of our institutional experience with ORTS provides a readily implementable framework for other, similarly structured institutions. Following exercise completion, the majority of participants identified a number of opportunities for improvement, at personal, team, and institutional levels. Consequently, we recommend other trauma centers (and institutions where similar experiences may be of value) to consider this approach to maintaining readiness, especially across “mission-critical” areas of team performance.

Acknowledgment

The authors would like to acknowledge the following trauma simulation participants, in alphabetical order: Kenda Bartholomew, James Cipolla MD, Katelyn Getz RN, Abigail Gotsch MD, Kathryn Kelley MD, Ryan Kennedy, Kyle Rice RN, Christopher Sellers RN, Charlene Stackhouse RN, Kaylin Stratton RN, Julia Tolentino MD, Doreen Young RN.

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