1. Chuck Biddle CRNA, PhD Chuck Biddle CRNA, PhD Professor Professor Virginia Commonwealth University Virginia Commonwealth University Staff Anesthetist Staff Anesthetist Department of Anesthesiology Department of Anesthesiology VCU Medical Center VCU Medical Center Patient Safety Vignettes: Enhancing Clinical Communication & Patient Safety In The Hospital Setting

2. What is a Trigger Film? Brief audio-visual vignette Simulates real-life situation, finishes abruptly; may or may not commit to a particular course of action Clinician reflects upon and analyzes real- life predicaments in a safe environment

4. Primary Goal Facilitate patient safety by modeling real-life adverse and catastrophic events while nurturing clinicians’ appreciation and response

5. Life At The Sharp End

6. Active errors / Latent Conditions Active errors Frontline provider actions Frontline provider inactions Latent conditions Dysfunctional organizational structure Dysfunctional organizational policy Inadequate training Faulty communication

7. Inspire cultural change by storytelling Inspire cultural change by storytelling Power of stories recognized by patient safety departments Power of stories recognized by patient safety departments Reenactments of adverse events & near misses via Reenactments of adverse events & near misses via story telling can raise and imprint awareness story telling can raise and imprint awareness Nothing more compelling than a well-told story? Nothing more compelling than a well-told story? An effective, low-tech approach An effective, low-tech approach

8. Trigger Film Development Foundations Based upon actual events Evidence-based interventions Vicariousness advantaged “Ecological validity”

9. Hospital-level Patient Safety Indicators (20 Indicators) Complications of anesthesia (PSI 1) Death in low mortality DRGs (PSI 2) Decubitus ulcer (PSI 3) Failure to rescue (PSI 4) Foreign body left in during procedure (PSI 5) Iatrogenic pneumothorax (PSI 6) Selected infections due to medical care (PSI 7) Postoperative hip fracture (PSI 8) Postoperative hemorrhage or hematoma (PSI 9) Postoperative physiologic and metabolic derangements (PSI 10) Postoperative respiratory failure (PSI 11) Postoperative pulmonary embolism or deep vein thrombosis (PSI 12) Postoperative sepsis (PSI 13) Postoperative wound dehiscence in abdominopelvic surgical patients (PSI 14) Accidental puncture and laceration (PSI 15) Transfusion reaction (PSI 16) Birth trauma -- injury to neonate (PSI 17) Obstetric trauma -- vaginal delivery with instrument (PSI 18) Obstetric trauma -- vaginal delivery without instrument (PSI 19) Obstetric trauma -- cesarean delivery (PSI 20)

10. “Center for Research in Human Simulation” “Center for Research in Human Simulation” Virginia Commonwealth University Richmond, Virginia A virtual OR, ED, patient room, x-ray room, office waiting room, blood drawing suite,…………..etc.

11. High-Fidelity Environment Control room 1-way mirror Med Sim Man ( virtual!) ( virtual!) Multiple camera & audio devices throughout room Modern, real- world equipment

13. Easily Produced / Economical

14. --Easily Disseminated--

15. Identify Problem Areas QA / RM office Departmental databases M&M conferences / Clinician input Target common themes Target catastrophic themes Model simulations Produce TFs Expose stakeholders To TFs Measure outcome costefficacyalternatives

16. Efficacy??? Currently exploring TFs in terms of: How do they impact safety? How do they impact safety? Do they alter behavior over time? Do they alter behavior over time? Better at prevention than remediation? Better at prevention than remediation? Cost effectiveness? Cost effectiveness?

17. Current Projects Underway Failure to properly consent for a patient procedure Failed hand-washing  life-threatening infection “Error of the decimal” leads to cardiac arrest Blood harvesting / labeling error  patient death Patient falls from gurney  severe internal injury Transition of care  drug administration misadventure

18. Lahaye L, Biddle C. Errors in healthcare. Part I. Curr Rev Anesth. 2003;26:67-72 Lahaye L, Biddle C. Errors in healthcare. Part II. Curr Rev Anesth. 2003;26:79-86 Biddle C, Hartland W, Fallacaro MD. Patient safety vignettes: Preliminary observations. Internet Journal Health Sciences and Practice. http://ijahsp.nova.edu. ISSN 1540-580X.http://ijahsp.nova.edu Biddle C. Reducing error and morbidity in the healthcare setting. Curr Rev Anesth. 2006;29149-160 Coopsman V, Biddle C. Performance using a handheld, computerized, decision making aid during critical events: a randomized controlled trial. AANA JO. 2008;76:29-36 Hartland W, Biddle C, Fallacaro M. Audio-visual facilitation of clinical knowledge: A Paradigm based on Paivio’s dual coding theory. AANA JO. 2008;76:194-198. Partial bibliography