Patient%20Safety%20Vignettes:%20%20Enhancing%20Clinical%20Communication%20

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Patient Safety Vignettes Enhancing
ClinicalCommunication Patient SafetyIn The
Hospital Setting

Chuck Biddle CRNA, PhD Professor
Virginia Commonwealth University Staff
Anesthetist Department of Anesthesiology
VCU Medical Center
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What is a Trigger Film?

• Brief audio-visual vignette
• Simulates real-life situation, finishes abruptly
  may or may not commit to a particular course of
  action
• Clinician reflects upon and analyzes real-life
  predicaments in a safe environment

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Primary Goal

• Facilitate patient safety by modeling real-life
  adverse and catastrophic events while nurturing
  clinicians appreciation and response

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Life At The Sharp End
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Active errors / Latent Conditions

• Active errors
• Frontline provider actions
• Frontline provider inactions
• Latent conditions
• Dysfunctional organizational structure
• Dysfunctional organizational policy
• Inadequate training
• Faulty communication

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• Inspire cultural change by storytelling
• Power of stories recognized by patient safety
  departments
• Reenactments of adverse events near misses via
• story telling can raise and imprint awareness
• Nothing more compelling than a well-told story?
• An effective, low-tech approach

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Trigger Film Development

• Foundations
• Based upon actual events
• Evidence-based interventions
• Vicariousness advantaged
• Ecological validity

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Hospital-level Patient Safety Indicators (20
Indicators) Complications of anesthesia (PSI 1)
Death in low mortality DRGs (PSI 2) Decubitus
ulcer (PSI 3) Failure to rescue (PSI 4) Foreign
body left in during procedure (PSI 5) Iatrogenic
pneumothorax (PSI 6) Selected infections due to
medical care (PSI 7) Postoperative hip fracture
(PSI 8) Postoperative hemorrhage or hematoma
(PSI 9) Postoperative physiologic and metabolic
derangements (PSI 10) Postoperative respiratory
failure (PSI 11) Postoperative pulmonary
embolism or deep vein thrombosis (PSI 12)
Postoperative sepsis (PSI 13) Postoperative
wound dehiscence in abdominopelvic surgical
patients (PSI 14) Accidental puncture and
laceration (PSI 15) Transfusion reaction (PSI
16) Birth trauma -- injury to neonate (PSI 17)
Obstetric trauma -- vaginal delivery with
instrument (PSI 18) Obstetric trauma -- vaginal
delivery without instrument (PSI 19) Obstetric
trauma -- cesarean delivery (PSI 20)
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Center for Research in Human Simulation
Virginia Commonwealth UniversityRichmond,
Virginia
A virtual OR, ED, patient room, x-ray room,
office waiting room, blood drawing
suite,..etc.
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High-Fidelity Environment
Modern, real- world equipment
Control room 1-way mirror Med Sim Man (
virtual!) Multiple camera audio
devices throughout room
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Easily Produced / Economical
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--Easily Disseminated--
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Identify Problem Areas QA / RM
office Departmental databases MM conferences /
Clinician input
Target common themes Target catastrophic themes
Measure outcome cost efficacy alternatives
Model simulations Produce TFs
Expose stakeholders To TFs
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Efficacy???

• Currently exploring TFs in terms of
• How do they impact safety?
• Do they alter behavior over time?
• Better at prevention than remediation?
• Cost effectiveness?

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Current Projects Underway

• Failure to properly consent for a patient
  procedure
• Failed hand-washing ? life-threatening infection
• Error of the decimal leads to cardiac arrest
• Blood harvesting / labeling error ? patient death
• Patient falls from gurney ? severe internal
  injury
• Transition of care ? drug administration
  misadventure

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Partial bibliography
Lahaye L, Biddle C. Errors in healthcare. Part
I. Curr Rev Anesth. 20032667-72 Lahaye L,
Biddle C. Errors in healthcare. Part II. Curr
Rev Anesth. 20032679-86 Biddle C, Hartland W,
Fallacaro MD. Patient safety vignettes
Preliminary observations. Internet Journal Health
Sciences and Practice. http//ijahsp.nova.edu.
ISSN 1540-580X. Biddle C. Reducing error and
morbidity in the healthcare setting. Curr Rev
Anesth. 200629149-160 Coopsman V, Biddle C.
Performance using a handheld, computerized,
decision making aid during critical events a
randomized controlled trial. AANA JO.
20087629-36 Hartland W, Biddle C, Fallacaro M.
Audio-visual facilitation of clinical knowledge
A Paradigm based on Paivios dual coding theory.
AANA JO. 200876194-198.
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