Using Simulation To Improve Patient Care

"AHRQ's investment in health care simulation has helped our team to advance the science and application of human factors to improve our understanding of, and ability to improve, the care of patients during care transitions and life-threatening events."

As professor of anesthesiology, biomedical informatics, and medical education at Vanderbilt University School of Medicine in Nashville, Tennessee, Matthew B. Weinger, M.D., has a unique vantage point on how to use health care simulation to improve patient safety. With AHRQ funding, he has studied ways to better understand the human factors affecting anesthesia care and how simulation can help to improve care processes and clinician performance.

Health care simulation is a technique that mimics real-world clinical events in a training environment so that clinicians can practice responding to urgent situations without the risk of harming patients. Just as airline pilots train on flight simulators, health care simulation is now routinely used in medical training to provide a safe space for students to learn new techniques.

In 2001, Dr. Weinger received his first AHRQ grant and started work that helped to create the foundation of his subsequent health care simulation research. In this initial project, Dr. Weinger and his team applied human factors techniques from other high-risk industries to develop methods to capture "non-routine events" as a way to study a broad array of care system attributes or conditions that could negatively affect patient safety. This early work helped to delineate performance-shaping factors (such as expertise, distractions, miscommunication, and poor medical device user interface) that have since been incorporated into simulation training and research.

In 2006, Dr. Weinger received additional AHRQ funding to study how health care simulation could help to address some of these performance-shaping factors. He started with communication failures, known to be a major contributor to adverse events related to surgery. In 2006, Dr. Weinger began an AHRQ-funded study to assess whether interdisciplinary simulation-focused training would improve communication during post-operative handoffs between anesthesia providers and nurses in post-anesthesia care units (PACUs). In the study, the intervention improved the quality of actual PACU handoffs substantially, an effect that persisted for up to 3 years after the initial training. Further, once enough clinicians had been trained, even those who had not undergone formal simulation training exhibited better actual handoffs, suggesting that simulation-based interventions can not only change individual real-world behavior, but also unit-level culture.

Dr. Weinger followed this research with a 3-year study that used simulation to assess the performance of practicing anesthesiologists managing crisis events during Maintenance of Certification courses. His team found that using a simulation-based assessment helped to identify performance gaps, highlighting areas that practicing anesthesiologists could focus on in continuing medical education activities.

Most recently, Dr. Weinger received a 5-year AHRQ grant to study the decisionmaking strategies of practicing anesthesiologists managing simulated life-threatening emergencies common to all types of acute care clinicians (e.g., heart attacks and breathing crises). The study, which ends in 2023, is expected to generate best-practice guidelines on decisionmaking and decision support for critical event management. The information is expected to guide policymaking about the content, execution, and timing of simulation-based training and assessment.

In addition to his teaching and clinical responsibilities, Dr. Weinger is the Norman Ty Smith Chair in Patient Safety and Medical Simulation and Director of the Center for Research and Innovation in Systems Safety (CRISS), at Vanderbilt University Medical Center in Nashville, Tennessee. He is on the Board on Human Systems Integration (BOHSI) of the National Academies of Sciences, Engineering, and Medicine (the National Academies) and is a member of its recently constituted Committee on Systems Approaches to Improve Patient Care by Supporting Clinician Well-Being. Dr. Weinger was the 2018 recipient of the J. S. Gravenstein Award from the Society for Technology in Anesthesia (STA) for "significant contributions to the advancement of anesthesia technology throughout his career."

Principal Investigator: Matthew B. Weinger, M.D., M.S., Professor of Anesthesiology, Biomedical Informatics, and Medical Education
Institution: Vanderbilt University Medical Center
Grantee Since: 2001
Type of Grant: Various

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