Simulatieonderwijs

Een koopje?

Prof. Dr. Cor J. KalkmanDr. Rob(ert) A. Lichtveld

Simulatieonderwijs

Is kosteneffectief:

A. Eens!B. Oneens!

Veiligheid denken

• To err is human• Preventie vermijdbare

schade• Minder tijd beschikbaar

voor klinisch werk

•

Thank God it ’’’’s Friday!

operations performed on Fridays were associated with a higher 30-day mortality rate than those performed on Mondays through Wednesdays: 2.94% vs. 2.18%;Odds ratio, 1.36; 95% CI, 1.24–1.49)

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Patients with an uneventful course had mean costs per case of US$ 27,946. Costs increased dramatically with the severity of postoperative complications and reached the mean costs of US$ 159,345 for grade IV complications.

(Ann Surg 2011;254:907–913)

10(Ann Surg 2011;254:907–913)

Kosten indicatie per cursist

• Assessments ongeveer 500-550€• Simulatieonderwijs ongeveer 400-450€

• METS

‘Before-after’ study with control group in the Netherlands: 3760 patients before implementation of the checklistvs. 3820 after implementation,Complications: 27.3 � to 16.7% (95% CI, 15.6 to 17.9).In-hospital mortality: 1.5% (95% CI, 1.2 to 2.0) to 0.8% (95% CI, 0.6 to 1.1)control hospitals: no change in outcomes

SURPASS- group: E.N. de Vries, M.A. Boermeester

Training health young doctorsin patient safety

safety curriculum teaching goals:

• Technical: ‘profession-specific’ error management

• ABCD: recognizing and treating vital instability

• Communication skills• inter-professional• with the patient

• human factors• Understanding accident investigation

Learning from High Reliability Organisations

’Aviation style ’ Readback/Hearback: the answer to medical communication errors?

Joint Comm J Qual Saf, 2004

Authority gradients

dealing with your ‘bully’ boss

learning to ‘speak up’

March 27, 1977:

KLM 747-200 and PanAm 747-100 crash into each other on

runway, Tenerife, Canary Islands.

death toll: 578

Trans Authority Cockpit gradient

Captain First Officer / Flight Engineer

“level of authority”

“Optimum”

Too steep: authoritive captain / weak F/O will not speak up

captain first officer

Simulatie soorten: partial task, low fidelity

Op de werkplek, laagdrempelig

Full scale simulation / CRM

High fidelity‘nep OK/ IC/ SEH’

Anesthesie team of hele OK team

Training health care workers in patient safety:

Teaching devices:

• Classroom: lectures and workshops

• Partial simulators:

• procedure trainers (‘plastic’)

• simulated communication using actors:

• communicating with the patient after a serious incident

• Computer games: teaching basic conceptsin a fun and interactive way

• Full scale simulators with actors (OR, ER, ICU, obstetrics): trend: simultaneous training of technical and non-technical skills

‘real’ drugs….

a ‘real’ surgeon….

Call for help … Now!….

Debriefing….

Kosten

• Weinig studies (6%) van 967 vergelijkende studies rapporteren over de kosten

• Minder dan 2% rapporteert vergelijkbare kosten

• Zendejas,B, et al Surgery 2013: 153(2) 160 76

Examples of Successful Training with Simulation

Top Gun Fighter Weapon School Improved Navy exchange ratio in air combat over North Vietnam from 2.4 to 12.5

Commercial Airlines FAA: Simulator training alone qualifies a pilot to fly a new airplane for the first time on a revenue flight

Nuclear power plants No significant accidents (after Three Mile Island) in military and civilian operations

Canadian Armor Trophy Extensive training with SIMNET and UCOFT helped Army win CAT for the first time in 1987

Landing on the Moon Actual Training not possible on Earth

Ervaringen uit de luchtvaart

� Verplicht gebruik van simulatie

� Standaard en bijzondere procedures

� Kostenreductie� Kosten zijn

geïncludeerd in business model

Waarom is simulatie zo effectief? Why Use Simulations?

Retention

Teach others 90% Integrated Simulation

Teach by doing yourself 75% Simulation

Discussion groups 50% Web Seminars, IM, chat

Demonstration 30% Animation

Audio Visual 20% PowerPoint dia´s

Lecture 5% Streaming media

Source: Andersen Consulting

Najjar, L. J. (1998). Principles of educational multimedia user interface design. Human Factors, 40(2), 311-323.Najjar, L. J. (1998). Principles of educational multimedia user interface design. Human Factors, 40(2), 311-323.

De afbeelding kan momenteel niet worden weergegeven.

Niveaus van evaluatie

�Lucius Annaeus Seneca (ca. 4 v.Chr.-65 n.Chr.)

“Errare humanum est”

…maar het is ook menselijk om fouten te voorkomen!

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A C A D E M I C MED I C I N E, VO L . 7 8 , NO. 8 / AU G U S T 2 0 0 3

…there seems little question that SBME has the potentialto decrease the numbers and effects of medical errors, To facilitate open exchange in training situations, to enhance patient safety, and to decrease the reliance on vulnerable patients for training…

Foutenreductie m.b.v.

Crisis Resource Management

Simulatieonderwijs

Is kosteneffectief:

A. Eens!B. Oneens!

Simulatieonderwijs:

Niet alleen voor aios, ook voor ervaren specialisten!

’profcheck ’

A.Oneens!B.Eens!

Hartelijk dank voor uw aandacht

of beter gezegd:

HOUD UW AANDACHT ERBIJ!

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Limited evidence suggests that improvements in patient outcomes attributable to simulation exercises

can occur at the health system

level.