The November special issue on errors

A Preliminary Audit of Interruptions in Intensive Care: Implications for Patient Safety

Interruptions occur throughout clinical practice. They occur during ward rounds, procedures, discussions with relatives or specialists, while checking drugs or equipment, when prescribing and writing in notes. They can take the form of face-to-face interaction, telephone calls or text messages, pagers, alarms on monitors or equipment. They may be for mundane reasons, low priority or urgent. They may be for relaying information, to refer patients, to discuss plans, to arrange treatment or investigations. Some are unnecessary and potentially unsafe, but others are essential re-directions to more urgent clinical situations. It may be that educational interventions could be used to reduce the detrimental effects of ill-timed interruptions and to promote effective re-directional interruptions.

Education and simulation techniques for improving reliability of care

PURPOSE OF REVIEW

Multiple factors influence the dependability of intensive care provision. The management of a group of unstable, critically ill patients requires focused attention from the clinical team. Medical simulation is an important tool to improve safety and team work within the ICU.

RECENT FINDINGS

The critical care healthcare team needs to work both individually and together in such a way as to optimise patient care and prevent error. This involves nontechnical skills including decision making, task allocation, team working and situation awareness, all of which are underpinned by communication, cooperation and coordination. The use of integrated simulators to create realistic patient scenarios with structured debriefing is an excellent method for teaching in these domains. There has been a huge increase in the delivery of training and education using an expanding variety of clinical simulators.

SUMMARY

This review summarises the evidence and opinion about how simulation tools can be optimally used. In addition, we propose an educational strategy to optimise the impact on clinical practice by embedding simulation training in a multidisciplinary teaching programme based upon a specifically developed curriculum focusing on the teaching of crisis resource management and patient safety.