Simulatieonderwijs Een koopje?

Size: px

Start display at page:

Download "Simulatieonderwijs Een koopje?"

Shannon Victor Higgins
8 years ago
Views:

1 Simulatieonderwijs Een koopje? Prof. Dr. Cor J. Kalkman Dr. Rob(ert) A. Lichtveld

2 Simulatieonderwijs Is kosteneffectief: A. Eens! B. Oneens!

3 Veiligheid denken To err is human Preventie vermijdbare schade Minder tijd beschikbaar voor klinisch werk

4 Thank God it s Friday! operations performed on Fridays were associated with a higher 30-day mortality rate than those performed on Mondays through Wednesdays: 2.94% vs. 2.18%; Odds ratio, 1.36; 95% CI, )

6 6

9 (Ann Surg 2011;254: ) Patients with an uneventful course had mean costs per case of US$ 27,946. Costs increased dramatically with the severity of postoperative complications and reached the mean costs of US$ 159,345 for grade IV complications. 9

10 (Ann Surg 2011;254: ) 10

11 Kosten indicatie per cursist Assessments ongeveer Simulatieonderwijs ongeveer METS

12 SURPASS- group: E.N. de Vries, M.A. Boermeester Before-after study with control group in the Netherlands: 3760 patients before implementation of the checklist vs after implementation, Complications: 27.3 to 16.7% (95% CI, 15.6 to 17.9). In-hospital mortality: 1.5% (95% CI, 1.2 to 2.0) to 0.8% (95% CI, 0.6 to 1.1) control hospitals: no change in outcomes

13 Training health young doctors in patient safety safety curriculum teaching goals: Technical: profession-specific error management ABCD: recognizing and treating vital instability Communication skills inter-professional with the patient human factors Understanding accident investigation

recognizing and treating vital instability Communication skills

14 Learning from High Reliability Organisations

15 Aviation style Readback/Hearback: the answer to medical communication errors? Joint Comm J Qual Saf, 2004

16 Authority gradients dealing with your bully boss learning to speak up

17 March 27, 1977: KLM and PanAm crash into each other on runway, Tenerife, Canary Islands. death toll: 578

18 level of authority Trans Authority Cockpit gradient Too steep: authoritive captain / weak F/O will not speak up Optimum captain Captain first officer First Officer / Flight Engineer

19 Simulatie soorten: partial task, low fidelity Op de werkplek, laagdrempelig

20 Full scale simulation / CRM Anesthesie team of hele OK team High fidelity nep OK/ IC/ SEH

21 Training health care workers in patient safety: Teaching devices: Classroom: lectures and workshops Partial simulators: procedure trainers ( plastic ) simulated communication using actors: communicating with the patient after a serious incident Computer games: teaching basic concepts in a fun and interactive way Full scale simulators with actors (OR, ER, ICU, obstetrics): trend: simultaneous training of technical and non-technical skills

23 real drugs.

24 a real surgeon.

25 Call for help Now!.

26 Debriefing.

27 Kosten Weinig studies (6%) van 967 vergelijkende studies rapporteren over de kosten Minder dan 2% rapporteert vergelijkbare kosten Zendejas,B, et al Surgery 2013: 153(2)

28 Examples of Successful Training with Simulation Top Gun Fighter Weapon School Commercial Airlines Nuclear power plants Canadian Armor Trophy Landing on the Moon Improved Navy exchange ratio in air combat over North Vietnam from 2.4 to 12.5 FAA: Simulator training alone qualifies a pilot to fly a new airplane for the first time on a revenue flight No significant accidents (after Three Mile Island) in military and civilian operations Extensive training with SIMNET and UCOFT helped Army win CAT for the first time in 1987 Actual Training not possible on Earth

29 Ervaringen uit de luchtvaart Verplicht gebruik van simulatie Standaard en bijzondere procedures Kostenreductie Kosten zijn geïncludeerd in business model

30 De afbeelding kan momenteel niet worden weergegeven. Waarom is simulatie zo effectief? Why Use Simulations? Retention Teach others 90% Integrated Simulation Teach by doing yourself 75% Simulation Discussion groups 50% Web Seminars, IM, chat Demonstration 30% Animation Audio Visual 20% PowerPoint dia s Lecture 5% Streaming media Source: Andersen Consulting Najjar, L. J. (1998). Principles of educational multimedia user interface design. Human Factors, 40(2),

31 Niveaus van evaluatie

32 Errare humanum est maar het is ook menselijk om fouten te voorkomen! Lucius Annaeus Seneca (ca. 4 v.chr.-65 n.chr.)

33 A C A D E M I C MED I C I N E, VO L. 7 8, NO. 8 / AU G U S T there seems little question that SBME has the potential to decrease the numbers and effects of medical errors, To facilitate open exchange in training situations, to enhance patient safety, and to decrease the reliance on vulnerable patients for training 33

34 Foutenreductie m.b.v. Crisis Resource Management

35 Simulatieonderwijs Is kosteneffectief: A. Eens! B. Oneens!

36 Simulatieonderwijs: Niet alleen voor aios, ook voor ervaren specialisten! profcheck A.Oneens! B.Eens!

37 Hartelijk dank voor uw aandacht of beter gezegd: HOUD UW AANDACHT ERBIJ!

38 Limited evidence suggests that improvements in patient outcomes attributable to simulation exercises can occur at the health system level. 38

EMERGENCIES IVAO BE 28 OCT. 2006. by Bob van der Flier IVAO-TA12 & PATCO

EMERGENCIES IVAO BE 28 OCT. 2006. by Bob van der Flier IVAO-TA12 & PATCO De afbeelding kan niet worden weergegeven. Het is mogelijk dat er onvoldoende geheugen beschikbaar is op de computer om de afbeelding te openen of dat de afbeelding beschadigd is. Start de computer opnieuw