Patient safety requires that clinical personnel understand why they do what they do. But patient safety involves many other aspects. These include:
1. Being alert
2. Planning ahead
3. Knowing your basics, and beyond
4. Rapidly recognizing a problem
5. Rapidly thinking your way through a problem
6. Practicing difficult situations until they become second nature
7. Practicing on new devices (e.g., monitors, anesthesia machine) or new drugs before using them on real patients
8. Knowing the problems that different patient diseases present
9. Understanding the consequences of different problems.
Simulation allows one to learn how to implement all these aspects of clinical practice. Inexpensive PC-based simulators allow individual learning and hours to days of practice under stress-free-or stressful conditions, depending on the need. Both are important.
There are two major categories of anesthesia simulators: Full mannequin operating room simulators, and PC-based simulators. Each type of simulator has its pros and cons, and they serve complementary roles in anesthesia, and hence in patient safety. Due to the lower cost of the PC-based type, the remainder of this article will focus on PC-based simulation devices—specifically, the commercially available BODY Simulation.
BODY Simulation is a PC-based, interactive, multi-media simulation that is based on mathematical models of patient physiology and pharmacology, an anesthesia workstation, and the operating room environment. These models present a sophistication and comprehensiveness not seen in most other simulators.
Two levels of interaction are available for the user of BODY: clinical training and its scientific background. He or she may obtain information by observing the patient, the anesthesia workstation, the ventilator, the monitors, or the record, by querying the state of the patient, or by using any of the insight-promoting scientific plotting and graphing tools. The user may thus carry out routine clinical tasks, or face common, or not so common, critical operating room incidents. All of the incidents outlined by Dr. Jeff Cooper in his critical incident presentations are available, and more. Finally, the user can interact with the operating-room personnel with the goal of solving operating room problems or critical incidents. Critical incidents can be combined. For example, one can put together a scary incident involving a leaking mask, difficult intubation, esophageal intubation and ultimate right mainstem intubation.
What other features of BODY allow one to achieve the patient-safety goals listed above, especially "knowing why you do what you do?" Scientifically oriented users may create their own drugs or patients with different physical-chemical or physiologic properties. Dynamic tables allow continuous viewing of respiratory variables. The user can generate kinetic plots of agent concentrations or masses in any compartment, as well as plots from a list of over 200 variables related to physiology, the anesthesia machine and the ventilator. X-Y plots show the pressure-volume and flow-volume curves. Dynamic Gas Display explains the workings of the anesthesia circuit, the ventilator and the transport of gases; and Drug Bars shows the concentrations and masses of a drug in all of the compartments—tissue and blood. These tools are invaluable in providing insight into the anesthetic process.
Although implemented on a reasonably priced PC, BODY allows excellent realism with its beating heart and breathing lungs, its realistic anesthesia machine and monitor, its detailed model and real compartments, and its ability to control every aspect of anesthetic administration. This control includes selecting and injecting or infusing drugs; setting up IV lines and infusing fluids; setting up the monitor and viewing it; conversing with the patient and OR personnel; asking for help from the circulating nurse or anesthesia assistant; and manually ventilating the patient. The user can implement clinical training, basic physiology or pharmacology education, or a combination of the above. One of the strong features of BODY is that it makes it possible to study the mechanisms behind clinical events in great detail, as well as to learn physiology and pharmacology in unique ways. It is possible to configure the software to assist teaching and enhance explanations of clinical, pharmacologic, physiologic, anesthesia machine, and critical incident scenarios. Thus, in addition to having a sophisticated model as its core, BODY Simulation has many features that make learning easier, more enjoyable, and more thorough than conventional methods.
Dr. Smith ([email protected]) is Professor Emeritus, University of California, San Diego.