The fine art of patient safety

What has long been compulsory for pilots is now also to bring greater safety in the event of critical incidents in the OR. As the first and largest cardiosurgical unit in Germany, the Herz- und Diabeteszentrum NRW in Bad Oeynhausen is introducing real-time simulator training for its surgical teams, headed by Prof. Dr. Jan Gummert.

This new development comes from the USA and was presented for the first time as an integrated, clinical pilot project in Germany at the Conference of the German Society for Thoracic, Cardiac and Vascular Surgery and Annual Cardiotechnology Conference in Weimar (11-13 November) by Markus Rudloff, Conference President and Head of Cardiotechnology at the Herz- und Diabeteszentrum NRW (HDZ NRW), Bad Oeynhausen. Only 30 simulator systems of this kind (manufacturer: Biomed Simulation Inc., San Diego) are currently in use around the world.

At the heart of this simulator now available to surgical teams in Germany is a software which records medical and technical information for anesthetists and cardiotechnicians during heart surgery. The unit used at the HDZ NRW replicates operating room situations: it comprises a dummy patient with an open thorax which is attached to all the necessary monitoring devices, as well as a heart-lung machine. Via a control panel, events in the OR can be simulated and emergency situations construed.

"From air travel we know that bad communication in the cockpit can lead to wrong decisions and endanger lives", Professor Gummert explained. "During a cardiosurgical intervention in the OR the situation is, if anything, even more volatile because on average eight to ten people are involved." The simulator-driven further training measure is not about surgical skills, but about perfect teamwork and minimization of the risks which can arise when coordination and communication are poor. "During surgery it is not the performance of an individual specialist which is crucial, but that of all the specialists who make up the team." Markus Rudloff added that in the future the simulator will become an integral part of cardiotechnical training.

Emergencies during surgery
Emergencies occur most frequently during cardiosurgery when the cardiovascular condition of the patient suddenly changes, a stressful situation for all involved. In order to determine the cause of the change as quickly as possible, it is imperative that surgeons, cardiotechnicians, anesthetists and nurses use unambiguous, direct and frank language to inform each other about their actions, but also about medical parameters, as well as potential technical problems.

"With the help of the simulator it should be possible to pinpoint the individual, organisational, technical or maybe even hierarchical factors which can be detrimental to the team members and the team environment", Markus Rudloff said, describing the new further training measure which will be conducted at the HDZ NRW on a rotational basis from the coming year. One challenge will be the multitude of informational dependencies. The surgeon depends on correct information from the anesthetist and the cardiotechnician. The anesthetist requires important information about laboratory data and use of the heart-lung machine from the cardiotechnician in order to monitor the vital parameters. And the surgical nurses must be informed about surgical procedures in order to hand over sterile instruments and supplies at the correct time.

Over 4,000 cardiosurgical interventions per annum
"It is all a matter of training, whereby our initial focus will be directed at the surgeon-anesthetist-cardiotechnician trio, with the goal of continually improving all processes", Professor Gummert said. His Clinic for Thoracic and Cardiovascular Surgery performs the most cardiosurgical interventions in Germany, in 2015 more than 4,100 operations on the heart and coronary vessels, the majority of which involved the heart-lung machine.

The HDZ NRW is particularly well known for its minimally invasive cardiosurgical interventions, as well as for being Europe's largest heart transplant center. The specialized hospital for the care of heart and diabetes patients is a member of the action alliance Patient Safety and has been awarded the seal of quality for communication and transparency in healthcare (KTQ) no less than three times. Simulation training is the next logical step after the qualified training and further training of staff, the establishment of a critical incident management system (CIRS) and numerous other clinical quality management measures.

Further information:
Herz- und Diabeteszentrum Nordrhein-Westfalen
Universitätsklinik der Ruhr-Universität Bochum
Presse- und Öffentlichkeitsarbeit
Leitung: Anna Reiss
Georgstr. 11
32545 Bad Oeynhausen
Tel. +49 5731 97-1955
Fax +49 5731 97-2028