Funded Projects
Simulation in health care creates a safe learning environment in which researchers and practitioners can test new clinical processes and enhance their individual and team skills. Many simulation applications involve artificial "patients" that can show symptoms and respond to simulated treatment, allowing practitioners to hone their clinical skills without putting patients at risk.
The Agency for Healthcare Research and Quality (AHRQ) supports simulation research through its patient safety program. This fact sheet summarizes grant awards for simulation research projects funded by AHRQ in Fiscal Year (FY) 2011.
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Contents
Introduction
Project Descriptions
More Information
Introduction
Simulation in health care creates a safe
learning environment that allows
researchers and practitioners to test new
clinical processes and enhance
individual and team skills before
encountering patients. Many simulation
applications involve mannequins that
present with symptoms and respond to
the simulated treatment, analogous to
flight simulators used by pilots
AHRQ supports
simulation research through the
Agency's patient safety program. In
2011, AHRQ funded 11 multi-year
demonstration grants to evaluate the use
and effectiveness of various simulation
approaches and the role they can play in
improving the safety and quality of
health care delivery. This fact sheet
briefly summarizes these new projects;
each summary includes the project title,
principal investigator and organization,
AHRQ grant number, project start and
end dates, and a description of the focus
and goals of the project.
Simulation has the potential to improve
the safety of health care by allowing
health care practitioners to acquire
valuable experience, in a variety of
clinical settings, without putting
patients at risk. These newly funded
projects will inform providers, health
educators, payers, policymakers,
patients, and the public about the
effective use of simulation in improving
patient safety.
|
Simulation allows health care
practitioners to acquire the
skills and valuable experience
they need safely, in a variety of
clinical settings, without putting
patients at risk.
|
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Project Descriptions
Immersive Simulation for Design and Evaluation of an Emergency Department IT
Principal Investigator: Ann Bisantz, PhD, State University of New York at Buffalo
AHRQ Grant No.: HS20433
Project Period: April 1, 2011 – March 31, 2014
Description: Emergency departments can be noisy
and confusing places where keeping
track of patients can be a challenge. The
goal of this project is to design and test
a prototype emergency department
information system with the potential to
track ED patients and improve
efficiency and safety, decrease ED wait
times, and decrease preventable injuries
to patients. The research team will use
simulation and cognitive systems
engineering methods to design and test
prototype ED information systems that
are based on an in-depth understanding
of the activities of caregivers and staff
within the ED. They will use a multiphase
strategy to model key aspects of
ED activities, iteratively develop
prototypes, and assess prototypes in a
simulated clinical environment.
Findings from this project will help
inform EDs as they implement
electronic information systems.
Improving Pediatric Resuscitation: A Simulation Program for the Community ED
Principal Investigator: Linda L. Brown, MD, Rhode Island Hospital, Providence, RI
AHRQ Grant No.: HS20286
Project Period: April 1, 2011 – March 31, 2014
Description: Pediatric emergencies with critical
consequences are an infrequent
occurrence in community hospitals, and
because they are rare, medical teams in
these hospitals have very few
opportunities to perfect their skill in
pediatric resuscitation. This research
team will use in situ medical simulation
to assess the ability of Rhode Island's
community emergency departments
(EDs) to perform pediatric
resuscitations. They aim to develop a
simulation-enhanced educational
intervention to improve the skills of ED
staff members and optimize the systems
required to perform pediatric
resuscitations effectively. The project
includes the implementation of a
statewide, simulation-enhanced,
evidence-based education intervention
and an evaluation of the effectiveness
and sustainability of the intervention
through ongoing assessments and review
of actual patient care.
Improved Patient Safety by Simulator-Based Training in Cardiac Surgery
Principal Investigator: Richard H. Feins,
MD, University of North Carolina at
Chapel Hill
AHRQ Grant No.: HS20451
Project Period:
May 1, 2011 – April 30, 2014
Description: In today's high-stakes operating room,
there often is insufficient time for
residents to learn surgical techniques by
apprenticeship, practice their skills, and
learn how to deal with adverse events.
The focus of this project is to
demonstrate that training in cardiac
surgery techniques can be improved by
combining cardiac surgery simulation
technology with a rigorous, simulation-based
curriculum. The researchers will
assess the effectiveness of using
simulator-based training in component
tasks of cardiac surgery and overall
procedures based on six modules: three
types of cardiac surgery and three
significant adverse events that can occur
during cardiac surgery. They will
employ a computer-controlled, tissue-based
cardiac surgery simulator that has
been shown to realistically duplicate an
actual patient undergoing cardiac
surgery. Eight institutions will
participate in the study. While the
project focuses on cardiac surgery
residents, the results potentially could
apply across a broad spectrum of
surgical practice.
Improving Patient Safety Through
Leadership and Team Performance in
Simulations
Principal Investigator: Rosemarie
Fernandez, MD, University of
Washington, Seattle, WA
AHRQ Grant No.: HS20295
Project Period:
July 1, 2011 – June 30, 2014
Description: Team leadership and team composition
are two important mediators of medical
emergency team performance that have
not been studied in patient safety
research. This project uses a 2 x 2
(unfamiliar vs. familiar teams and
leadership training vs. control) research
design to evaluate the impact of
leadership training and team
composition on ad hoc medical
emergency team performance. Ad hoc
medical emergency teams will comprise
emergency department nurses and
physicians from multiple hospitals. The
primary outcome measure is team
performance, which will be assessed
using a validated simulation-based
research platform (scenario + team
process measures + patient care
measures).
Acceleration to Expertise: Simulation
as a Tool to Improve the Recognition
of Sepsis
Principal Investigator: Gary L. Geis,
MD, Children's Hospital Medical
Center, Cincinnati, OH
AHRQ Grant No.: HS20455
Project Period:
April 1, 2011 – March 31, 2014
Description: Sepsis is a diagnostic challenge and a
leading cause of death worldwide.
Failure to recognize the early signs and
symptoms of sepsis and institute
aggressive management significantly
increases the risk of death for children
and adults. The central hypothesis of
this project is that simulation-based
training can accelerate the development
of expertise needed by novice clinicians
to quickly and accurately recognize
sepsis. By identifying the unique
elements of the expert's approach to
sepsis, an effective, simulation-based
approach might become possible.
Specifically, the research team will:
- Determine the behaviors that
characterize and differentiate the expert
from the novice in the recognition of
sepsis at the bedside.
- Develop
and implement simulation-based
learning interventions that accelerate the
development of expertise in relation to
sepsis recognition.
Using Simulation for Teaching
Femoral Arterial Access: A Multi-Centric Collaborative Approach
Principal Investigator: Hitinder S.
Gurm, MD, University of Michigan at
Ann Arbor
AHRQ Grant No.: HS20447
Project Period:
April 1, 2011 – March 31, 2014
Description: Vascular complications occur in
approximately 3 percent of patients
undergoing coronary intervention and
are associated with significant morbidity
and mortality. An increase in vascular
complications corresponds with the
beginning of the academic cycle, and
trainees have more complications in
their first few procedures than later
when they are more experienced. This
research team will develop and
implement a simulator to teach femoral
artery access using a three-step
approach:
- Development of a valid
simulation model that provides realistic
training for obtaining femoral arterial
access.
- Creation of a program to
incorporate the simulation model in the
educational curricula of cardiology
fellowships at four major institutions.
- Collection of followup data to
assess changes in complication rates
across the institutions.
Improving Physician and Nurse
Communication with Serious Gaming
Principal Investigator: Mary E. Mancini,
PhD, University of Texas, Arlington
AHRQ Grant No.: HS20416
Project Period:
April 1, 2011 – March 31, 2014
Description: Communication between physicians
and nurses often is less effective than it
could be, and ineffective interpersonal
communication has been identified as a
leading contributor to preventable
adverse events. Physicians and nurses
traditionally receive little if any direct
experiential training in communicating
effectively with each other, and
traditional methods for teaching
communication skills often are both
time-consuming and ineffective. These
researchers will develop and evaluate a
"serious" game to improve the
communication skills of practicing
physicians and nurses by increasing their
understanding about the impact of
ineffective interpersonal and interprofessional
communication. The game
will allow users to experiment with and
learn more effective communication
skills and behaviors through practice
and feedback.
Improving Cancer Care Patient Safety
Through Pathology Training
Simulation
Principal Investigator: Stephen S. Raab,
MD, University of Washington, Seattle,
WA
AHRQ Grant No.: HS20339
Project Period:
May 1, 2011 – April 30, 2014
Description: Uncontrolled variability in diagnostic
testing contributes to high rates of error
and increased costs. The incorporation
of simulation training in pathology
residency holds promise for reducing
variability. This research will determine
whether a simulation-based anatomic
pathology education combined with
Lean methods of quality improvement
is better than a traditional
apprenticeship for reducing errors in
formulating pathology diagnoses of
cancer in major solid organs. The
research team will conduct a double
cohort case-control study in a single
institution by separating residents on
the university hospital anatomic
pathology rotation into two groups:
- An integrated Lean-simulation-based
anatomic pathology education track.
- A traditional apprenticeship track.
They will compare resident performance
and patient safety outcomes in oncology
for the two tracks over a 3-year period.
Improving Patient Safety Related to
Medication Infusion Pump
Technology Using Systems
Engineering
Principal Investigator: Alan D. Ravitz,
MS, Johns Hopkins University,
Baltimore, MD
AHRQ Grant No.: HS20460
Project Period:
May 1, 2011 – April 30, 2014
Description: Clinicians are well aware of the
difficulties of using medication infusion
pumps and the associated threats to
patient safety, and they often adapt their
activities to the cumbersome design of
the infusion pump, rather than having
access to machines designed to meet
their needs. To address these
shortcomings, this research team will:
- Define clinician requirements in the
use of medication infusion pumps and
develop measures of effectiveness and
performance.
- Develop a rapid
prototype environment to test the
safety/usability of simulated infusion
pumps and develop prototypes based on
clinician requirements using systems
engineering best practices.
- Measure the safety and usability profile
of infusion pump designs in a simulated
intensive care unit setting.
A Secondary Task for Measuring
Laparoscopic Skill
Principal Investigator: Mark W. Scerbo,
PhD, Old Dominion University,
Norfolk, VA
AHRQ Grant No.: HS20386
Project Period:
September 30, 2011 - September 29, 2013
Description: Laparoscopic surgery imposes significant
visual-motor and attentional challenges
on the surgeon, potentially putting
patients at serious risk. Although
clinicians can use simulators to practice
their skills outside the operating room,
there is no standard method to
determine whether a surgeon has
achieved or maintained laparoscopic
proficiency. The objective of this project
is to validate a new secondary task that
targets the spatial skills needed to
mentally translate 2-D display images
into the 3-D operational space. The
researchers will use laparoscopic
simulators, porcine models, and fresh
cadavers to demonstrate that the
secondary task can be used to measure
characteristics of laparoscopic skill.
Successful demonstration of the
hardware/software system and objective
assessment methods hold good potential
for coupling to any spatial task where
surgeons use a video display to monitor
their activities.
Creating Simulation-Based
Performance Assessment Tools for
Practicing Physicians
Principal Investigator: Matthew B.
Weinger, MD, Vanderbilt University,
Nashville, TN
AHRQ Grant No.: HS20415
Project Period:
April 1, 2011 – March 31, 2014
Description: Assurance of physicians' ability to detect
and manage uncommon but potentially
lethal events is an area of particular
concern for which simulation-based
performance assessment may be ideally
suited. To test this approach, the
researchers will:
- Develop
standardized, generalizable simulation
scenarios and associated tools to
conduct simulation-based assessment of
board-certified anesthesiologists.
- Demonstrate that simulation-based
clinical assessment can be reliably
delivered across multiple national sites
to evaluate board-certified physicians
seeking recertification.
- Describe the
distribution of clinical performance
during simulation.
- Begin to
address the remaining challenges and
questions related to reliable and valid
simulation-based assessment of
practicing physicians' clinical
competency.
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More Information
For more information about the Agency
for Healthcare Research and Quality,
please visit the AHRQ Web site at
http://www.ahrq.gov.
For more specific
information on AHRQ's research
priorities and funding opportunities,
please visit http://www.ahrq.gov/fund/.
For specific programmatic questions
about simulation research and other
patient safety topics, please contact:
Kerm Henriksen, PhD
Agency for Healthcare Research and
Quality
540 Gaither Road
Rockville, MD 20850
Phone: 301-427-1331
E-mail: Kerm.Henriksen@ahrq.hhs.gov
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AHRQ Publication No. 11-P012-EF
Current as of September 2011
Internet Citation:
Improving Patient Safety Through Simulation Research: Funded Projects. AHRQ Publication No. 11-P012-EF, September 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/simulproj11.htm
540 Gaither Road Rockville, MD 20850 