SimGHOSTS: Our Role in Keeping Patients Safe
by guest author Sharmila Shankarkumar
When what's meant to save you might kill you
The statistics are chilling. They speak for themselves.
A 1999 Institute of Medicine Study found that up to 98,000 people die every year due to medical errors. In recent years, studies were conducted to reassess that number. Instead of it being lower, the revised estimate was significantly higher, at 440,000 deaths per year. So medicine – the science that is there to protect us – itself ranks up there, right after heart disease and cancer, as the third leading cause of death.
Even with medical errors, prevention is better than cure
In ages past, doctors usually started strenuous revival efforts when the patient's condition was fairly dire. Over time the responses to deterioration have started a lot earlier – it's much more effective to revive a patient when they're just showing initial problem symptoms rather than when they're halfway to meeting their maker.
Similarly, with safety issues, it's much better to get a head start. We now recognize that much of the safety problem is preventable. For medical errors overall, experts estimate that around half of the problem is preventable. The lowest hanging fruit are about 25 percent of the cases which fall into 12-15 categories1.
Time to count it, share it and fix it!
At this point you might be wondering, if these errors are preventable, why haven't we done anything about this already? Why is it still like this?
It's like this because people make mistakes. To err is human. But errors are not peculiar to medicine: everybody makes mistakes. Pilots do too, yet we don't see planes falling out of the sky every day. And when they do, a lot of people get very upset right away.
But when the planes fall out of the sky in health care, no one sees them.
And it's like that because the health care industry has for long failed to adopt a number of best practices that other industries like aviation have embraced: standardized measurement, transparency and an attitude of zero tolerance towards preventable errors. We're too complex, they say. The way you measure it is not how I measure it, and if we can't agree on how to count, we can't count it. We wont show our data to the public. And thus the compound effect of this set of obfuscations: a large number of preventable errors.
Take heart. It's not all bleak. Over the last several decades, a movement has gotten underway in counting errors, identifying patterns that allow an error to happen, and finding ways to respond proactively.
Simulation: A Vital Tool to Revolutionize Patient Safety
Research efforts are ongoing in multiple countries to identify the patterns of activity that lead to errors, and to codify best practices to prevent them. Since the 1970s, groundbreaking work on preventing errors in anesthesiology has been conducted in Australia2. In 1989, the establishment of the Agency for Health care Research and Quality (AHRQ) in America resulted in the creation of a vast trove of tools and best practices. Whole books have been written on the use of checklists. Hospitals have put in reminders for handwashing. Guidelines have been developed for handoffs. And researchers have put handwashing and handoffs on the checklists.
The underlying principle is to design the work environment assuming errors will happen – and then build a system of checks and balances to combat it.
While tools and best practices are instrumental in improving health care quality, there's nothing quite like practicing these best behaviors to build muscle memory. Today, the widespread prevalence of manikins and simulators in almost all locations where health professionals train and work is revolutionizing patient safety. Advances in technology are now helping us simulate environments, systems, and processes, and gather data to contribute to the growing evidence base of how to successfully address preventable errors. When new hospitals or treatment areas are being designed, the employees can simulate working in the proposed spaces to test for design flaws. They can also simulate working in the new environment so that they can learn where everything is before they actually begin work on real patients.
Simulation also provides an opportunity to test hypotheses in a controlled environment - one that is safe for patients. Researchers can simulate rare events or other situations, where it may be unethical or infeasible for medics to learn by experimentation, and find ways to improve care.
SimGHOSTS and Safety: Racing to Zero
SimGHOSTS' mission is to support this new chapter in patient safety. While simulation technologies have been in use for awhile, their role in patient safety is assuming greater importance as awareness of safety and quality issues grows, and as the medical community redoubles their efforts on getting to zero preventable errors.
Our mission is to support individuals and institutions operating medical simulation technology and spaces through hands-on training events, online resources, and professional development. We envision a health care education culture where people are empowered to use simulation technology to improve learning and patient outcomes.
We're proud to be a part of the race to zero.
 Setting Priorities for Patient Safety by Runciman, Edmonds and Pradhan, BMJ Quality and Safety, 2002
 Preventable Anesthesia Mishaps: A Study of Human Factors, by Cooper, Newbower, Long and McPeek, Anesthesiology 1978
Sharmila Shankarkumar is a health care professional and blogger who is passionate about health care quality and patient safety issues.