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Interprofessional Crisis Simulation Prepared Radiology Teams for Anesthesia Emergencies
Overview
What was the reason for the change?
Several safety incidents affecting patients under anesthesia in radiology settings prompted review of root causes. Many contributors and vulnerabilities pertaining to effective crisis management in these remote non-operating room locations were found. Crisis simulation training with participation of the entire multidisciplinary and interprofessional team were seen as a way to 1) inform process improvements, and 2) improve teamwork.
What were we trying to accomplish?
We wanted to strengthen communication and collaboration among interprofessional teams who do not frequently work together in nonoperating room anesthesia (NORA) locations. Specifically, we wanted to increase awareness of the correct processes to escalate care in NORA crisis situations, improve role understanding and communication between different professions, and enable nonanesthesia team members to call for help or retrieve airway and rescue equipment during a crisis. As our NORA sites experience high production pressure, we created a brief module that could be completed within 60 minutes and therefore could be scheduled in lieu of an educational conference or staff meeting, so as not to interfere with clinical care.
Implementation
How long did it take to get up and running?
It took about 6 months initially to create the training module and refine it. One limiting factor was to find meeting times for interprofessional and multidisciplinary stakeholder groups. It then took about another 4 months to conduct training sessions for the initial cohort of participants. For subsequent adaptations (the switch from one setting [MRI-OR] to another one [diagnostic MRI]), it took about 2-3 months of meetings and prep work including 1-2 in situ dry runs with local champions.
How was readiness assessed & required resources identified?
Our institution has a simulation center who supports patient safety initiatives such as the one described here. A high-fidelity mannikin was customized to be MRI-safe for use in MRI settings. Generally, the readiness or rather “need” to improve safety in these highly vulnerable settings was accepted by both leadership and most of the individuals working in these spaces who themselves were witnesses of or had reported previous safety events. The anesthesia representatives creating the module and organizing the sessions used protected time which was awarded for this project from departmental sources. Perioperative leadership permitted using the entire OR team for short time windows after conclusion of a surgical case in the MRI-operating room for dry runs or discussions to finalize the simulation sessions. For any future sessions or adaptations, similar buy-in from leadership in the affected departments will be needed to set aside time for these interprofessional trainings and the meetings necessary to create them. In addition, administrative help to schedule sessions, send invitations/reminders, and collect course feedback surveys will be needed.
What were the missteps and lessons learned along the way?
While these trainings were initially commissioned and fully by patient safety leadership, they were not formally included into the “mandatory” education program for working in MRI spaces or NORA spaces – in part because there is no single senior hospital leader with has authority over the different professions (nursing/scrub techs, imaging techs, anesthesia providers, proceduralists) and specialties (surgery, anesthesia, radiology). To continue this program, we would need to enshrine interprofessional simulation sessions into the hospital culture by offering them during specifically dedicated training times where they are not in conflict with patient care, so that participants are free to (and expected to) attend. The “mandatory nature” of the training sessions would in turn enable administrative staff to take ownership of scheduling these sessions and make this sustainable.
Solution Design
What changes can we make that will result in an improvement?
Create/expand realistic interprofessional simulation training modules for NORA settings and perform interprofessional trainings in regular intervals (such as quarterly, or annually, depending on number and turnover rate of involved personnel). Conduct the trainings and collect feedback from the participants.
What was your implementation strategy and critical steps?
The training was initially rolled out with a series or simulations intended to “capture” the entire workforce working at one specific site, the intraoperative MRI suite. Subsequently, 2-3 sessions were done annually to include new staff members. Next, a series of simulations in the diagnostic MRI suite (in radiology) were performed until all MRI staff had undergone training (at which time most anesthesia personnel also had attended at least one training session).
Adoption & Sustainability
How did you communicate the tactic to those affected by it?
Initial communications involved leadership of anesthesiology, radiology, OR nursing, later neurosurgery. In addition, those frontline staff involved in the “triggering” incidents were involved in designing and testing the simulation module and helped to spread the word. Ultimately, information about these trainings was communicated verbally during staff meetings and via email.
How did you design for sustainability of the change?
Initially, local leaders of MRI-OR and MRI suite, in collaboration with anesthesia NORA director and anesthesia simulation director, assumed the responsibility to organize and conduct the training sessions. Many of these roles have since been eliminated or experienced staff turnover. As outlined above, to make this program sustainable in the long term, buy-in from current operational leaders, designated time for training sessions (as little as one hour per quarter), and administrative support will be necessary.
Downloadable Resource
QI Report
Evidence & References
Other References
- Beard J, Methangkool E, Angus S, Urman RD, Cole DJ. Consensus Recommendations for the Safe Conduct of Nonoperating Room Anesthesia: A Meeting Report From the 2022 Stoelting Conference of the Anesthesia Patient Safety Foundation. Anesth Analg. 2023 Aug 1;137(2):e8-e11. doi: 10.1213/ANE.0000000000006539. Epub 2023 Jul 14. PMID: 37224074.
- Fung L, Boet S, Bould MD, Qosa H, Perrier L, Tricco A, Tavares W, Reeves S. Impact of crisis resource management simulation-based training for interprofessional and interdisciplinary teams: A systematic review. J Interprof Care. 2015;29(5):433-44. doi: 10.3109/13561820.2015.1017555. Epub 2015 May 14. PMID: 25973615.
- Gaba DM. Crisis resource management and teamwork training in anaesthesia. Br J Anaesth. 2010 Jul;105(1):3-6. doi: 10.1093/bja/aeq124. PMID: 20551023.
- Schroeck H, Boone MD, Rubenberg LA, Bryan YF. Anesthesia Emergencies in Hybrid Operating Rooms: Multidisciplinary Crisis Resource Management. APSF Articles Between Issues. Published online September 8, 2020. Accessed December 11, 2020. https://www.apsf.org/article/anesthesia-emergencies-in-hybrid-operating-roomsmultidisciplinary-crisis-resource-management
- crisis management
- NORA
- simulation
