AHRQ Issue Brief Shows How Simulation Can Help Protect Ebola Patients, Health Care Workers
Simulation has long been recognized as an important tool for promoting safety in high-risk industries. Our aerospace, transportation, and power-generation industries have become steadily safer over the years, in part by training workers through simulation.
As the Ebola virus disease is amply demonstrating, health care is also a high-risk industry. As part of preparedness efforts in responding to Ebola, simulation can detect threats to safety and establish high levels of individual and team performance.
Two imported cases, including one resulting in death, and two locally acquired cases in health care workers were reported in the United States in 2014, according to the CDC. In March 2015, a U.S. health care worker infected with the virus was admitted to the National Institutes of Health for treatment. The dedicated health providers who treat Ebola patients should not be expected to risk their lives when caring for the sickest patients.
A recently released AHRQ issue brief, "Health Care Simulation to Advance Safety: Responding to Ebola and Other Threats," underscores the potential of simulation to help prepare for Ebola and other emergent epidemics. The brief addresses simulation's essential features and benefits, approaches and uses, the concept of mastery learning, and AHRQ's programmatic focus on simulation.
Several simulation centers have already initiated simulation-based preparations to improve readiness for Ebola patients. AHRQ's new brief highlights progress at Northwestern University Feinberg School of Medicine, Chicago, where a team has demonstrated the value of using simulation-based preparations in addition to valid, detailed protocols.
Jeffrey H. Barsuk, M.D., M.S., associate professor of medicine at Northwestern, said using simulation to identify gaps in Ebola safety protocols found breaches in sterile technique when providers were fully donned in personal protective equipment, transporting Ebola patients, drawing blood from a peripheral intravenous catheter, and placing a central venous access line. Realistic drills and honest feedback allowed clinicians to address gaps and improve aspects of their preparedness to respond to real patients.
AHRQ's new issue brief also includes key lessons that demonstrate the value of simulation in today's complex health care settings. They include—
- Recognizing that simulation is not just for residents and nursing students—Educating and training health providers is a lifelong process, especially as new technologies, less invasive procedures, and new protocols make their way into clinical practice. Veteran clinicians might not fully appreciate the perils of climbing the learning curve with respect to patient safety as new and different skill sets are learned.
- Managing the unexpected—It is not possible to develop step-by-step protocols for every possible event related to rapidly emerging conditions. But simulation offers the chance to operationalize and test resiliency concepts, as well as learn about their anticipation and mitigation, before events worsen and create harm.
- Ensuring the effectiveness of simulations—Just as it takes considerable practice to acquire new skills, AHRQ-funded simulation investigators are learning that it takes practice and trial-by-error development for patient safety investigators to maximize the effectiveness of their simulations.
While the lessons learned are yet to be fully recorded and digested, the relevance of simulation extends not only to the immediate Ebola response but to other serious viral outbreaks and influenza threats. Although the number of patients with the Ebola virus to be admitted to U.S. hospitals is expected to be very low, the recent admission of the Ebola-infected health worker reminds us that this threat remains.
Richard Kronick, Ph.D, is Director of the Agency for Healthcare Research and Quality.
Page originally created March 2015