Since opening on August 24, 2008, the Abbotsford Regional Hospital and Cancer Centre (ARHCC) sits as the principal referral site in the Fraser East region. With a catchment area including more than 300,000 people, and servicing greater than 70,000 emergency room visits per year, it is well situated in one of the fastest growing regions of British Columbia. With its breadth of cardiac, intensive care, neonatal intensive care, dialysis, surgical and emergency services, the hospital continues each year to serve more patients with a greater complexity, many of which are initially stabilized within the emergency department prior to being admitted to a ward within the hospital.
Increased demands placed on staff dealing with a higher volume of more complex patients cause errors occur. Baker, et. al. found in their 2004 study that patient safety incidents are as high as 7.5% within Canada1. Furthermore, the Canadian Patient Safety Institute (CPSI) stated in their 2011 Literature Review that communication and teamwork failures are leading causes of patient safety incidents in health care, accounting for up to 70% of cases2. The report also recommends using simulation, whether high fidelity or low fidelity as a part of experiential learning as a means of improving the culture of patient safety within Canada.
Historically, simulation originated in areas that are too dangerous, too expensive, or unfeasible to replicate. Examples of such areas are the military, the airline industry and space exploration. The commonality amongst these industries is that they are highly complex organizations, susceptible to human error. Within healthcare, simulation first made an appearance in 1969 with Denson and Abrahamson at the University of California San Francisco with their SimOne anesthesia simulator. This was followed up in 1986 at Stanford with Gaba and De Anda simulating intraoperative anesthetic crises. Subsequently, simulation has since expanded throughout healthcare from anesthesia to many of the acute care specialties.
Many of the benefits garnered from high fidelity simulation have been from improved communication and teamwork, effected by the implementation of the principles of Crisis Resource Management (CRM). CRM focuses on techniques for improving situational awareness and communication within a team during critical scenarios. This allows teams to function more efficiently and effectively4. Within other domains, similar principles have led to a precipitous decline in airline crashes5 and anesthesia deaths have fallen from 6% in 1955, to five per million today. Moreover, the principles of CRM are now included in the 2010 Pediatric Advanced Life Support (PALS) guidelines, thus broaching mainstream healthcare.
Simulation improves knowledge, decreases the time it takes learners to complete tasks, improves procedural success, and helps avoid medical errors6. Furthermore, outcomes are better with simulation-based education compared to other methods of teaching7. High fidelity simulation will also help better prepare staff to deal with high acuity and low frequency events, which may ultimately prove to be life saving. The benefits of simulation have been seen in the manner by which both novice and experienced providers respond in critical situations8,9,10,11. Furthermore, practicing in the settings and with the individuals with whom you work will have the greatest benefit on patient care.
Currently, there is a vacuum of simulation training within Fraser Health. Simulation training is part of the curriculum of many medical residency programs, nursing critical care and trauma education and exists on site within many hospitals in both British Columbia and Canada. Despite this, there is a paucity of simulation training at ARHCC and within the Fraser East region. We have piloted Advanced Cardiac Life Support (ACLS) based simulation within the family medicine residency program locally, which has been very positively received; however the opportunities that exist for simulation locally are endless. Simulation allows people to err and debrief about their perceptions and mistakes in a non-judgmental and collegial environment. This will create opportunities to better recognize, identify and treat acute care conditions within the hospital, decreasing errors and critical incidents.
We foresee creating a simulation program based in the emergency department. This will be followed by an expansion to involve staff from other acute care departments. Furthermore, we envision positive outcomes in staff satisfaction, likely impacting recruitment and retention of staff. Such a program could also form the backbone of future medical residency programs at ARHCC. Once a simulation program is established, we hope to propagate our knowledge and experience to interested parties within the Fraser East region, including peripheral hospitals such as Mission Memorial Hospital, Fraser Canyon Hospital, Langley Memorial Hospital and to pre-hospital providers (Fire/EMS).
We have assembled a multidisciplinary group of interested individuals who are keen to teach and are committed to the development of a simulation program. Our group lead has completed the Simulation Educator Training (SET) course held at the Centre for Simulation Education and Innovation (CESEI) at Vancouver General Hospital and has considerable experience with simulation. Members of the team have used simulation extensively during residency training and critical care education, and currently teach with simulation in their practices. We are motivated to use our skills and experience of both education and simulation in Abbotsford.
There are many critical requirements needed to develop a high-fidelity simulation program. We require a renovated and dedicated space within ARHCC for a lab. We require money for capital expenditures as well as for ongoing costs of maintaining and replacing the equipment. We require political, financial and administrative support from the University of British Columbia, Fraser Health and from the hospital administration to create a program and to support our endeavors. We plan to solicit prominent philanthropists within Abbotsford and the lower mainland to help with the start-up costs of the program. To maintain the solvency of the program and for the maintenance of equipment, instructors will be paid and we will charge for use of the mannequin(s). Our goal is to create a self-sustaining program requiring minimal ongoing external support after the initial start-up period.
In summary, high fidelity human patient simulation is becoming the standard in health care, leading to fewer medical errors and improving providers’ responses to critical incidents. There is great opportunity locally to create such a program and we envision only positive benefits for patients, staff, the hospital and the region. The barriers to the program are large but surmountable with adequate political, administrative and financial support. We have a committed group of motivated individuals involved in this endeavor who are keen to develop and teach using simulation as a novel modality to the benefit of patient care.
Dr. Michael Yatscoff
BSc. MD. CCFP(EM)
Abbotsford Regional Hospital and Cancer Centre
Abbotsford Simulation Group Program Lead
1) Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, et al. The Canadian Patient Safety Incidents Study: the incidence of patient safety incidents among hospital patients in Canada. CMAJ. 2004 ;170(11): 1678-86
2) Lo, L. Teamwork and Communication Working Group. Improving patient safety with effective teamwork and communication: Literature review needs assessment, evaluation of training tools and expert consultations. Edmonton (AB): Canadian Patient Safety Institute; 2011.
3) Dunn, WF. Simulators in Critical Care and Beyond. Society of Critical Care Medicine. 2004. Des Plaines, IL.
4) Cheng, A., Et.al. Simulation-based crisis resource management training for pediatric critical care medicine: A review for instructors. Pediatr Crit Care Med 2012; 12:197-203.
5) Gladwell, M. Outliers: The Story of Success. 2008. Little, Brown and Company. New York, NY.
6) Cook, DA. Et.al. Technology-Enhanced Simulation for Health Professions Education: A Systematic Review and Meta-Analysis. JAMA. Sept 7, 2001. 306(9). 978-88.
7) Cook, DA. Et.al. Comparative Effectiveness of Technology-Enhanced Simulation Versus Other Instructional Methods: A Systematic Review and Meta-Analysis. Sim Healthcare 7:308-320, 2012.
8) Chopra et.al. Does team training on an anesthesia simulator lead to improvement in performance? Br J Anaesth 1994: 73: 293-7.
9) Wayne et.al. Simulation-based education improves the quality of care during cardiac arrest team responses at an academic teaching hospital: a case-control study. Chest 2008; 133;56-61.
10) Yee et.al. Nontechnical skills in anesthesia crisis management with repeated exposure to simulation-based education. Anesthesiology 2005; 103: 241-8.
11) Morgan et.al. Efficacy of high-fidelity simulation debriefing on the performance of practicing anesthetists in simulated scenarios. Br J Anaesth 2009; 103: 531-7.