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CORE Simulation Program Meets Operating Room Infrastructure Training Need

June 2017

CORE simulation training sessionWhen rare but potentially devastating emergencies arise in the operating room, swift, efficient, and interdisciplinary teamwork is critical to patient safety. Prior studies have shown that simulation-based team practice in preventing and managing such events can improve team effectiveness, reduce risks, mitigate declines in infrequently used skills, and lead to design of new and better processes of care. Inspired by these observations, Sharon Muret-Wagstaff, PhD, MPA, director of the high fidelity simulation program for Emory's Carlos and Davis Center for Surgical Anatomy and Technique (CSAT), founded the Co-management of Operating Room Emergencies (CORE) Simulation Program.

Conceived and executed as a collaborative effort of the departments of surgery and anesthesiology of the Emory University School of Medicine and the patient care and nursing services of Emory University Hospital (EUH), CORE's objectives are to enable operating room teams to enhance patient safety through the use of checklists; closed loop communication between team members, with the receiver repeating back the sender's message for confirmation to avoid misunderstandings; and crew resource management, a set of communication, leadership, and decision-making training procedures initiated in the aviation industry for use in environments where human error can have life threatening consequences.

After establishing a CORE faculty leadership team of Joe Sharma, MD, and Virginia Shaffer, MD, of the Department of Surgery; Michele Sumler, MD, and Darlene Mashman, MD, of the Department of Anesthesiology; and Kate Pettorini, RN, CNOR, of the EUH operating room staff; Dr. Muret-Wagstaff and the team designed and prioritized perioperative scenarios that would be enacted on a monthly basis in the mock operating room at the Emory Center for Experiential Learning (ExCEL) simulation facility. The six sessions they have held thus far have included three operating room or perioperative scenarios, debriefing of each scenario, and participant insights and recommendations.

"The interdisciplinary teams at the CORE training sessions consist of a minimum of two attending surgeons, two attending anesthesiologists, and two nurses, with additional participants as appropriate," says Dr. Muret-Wagstaff. "Potential scenarios include events such as hemorrhage, fire, local anesthetic toxicity, malignant hyperthermia, oxygen failure, power failure, transfusion reaction, venous air embolus, and Advanced Cardiac Life Support events, prioritized by findings from past Emory adverse events, closed claims analysis, the Stanford Emergency Manual, and the literature from health care, aviation, and other high-stakes industries."

As a CORE session participant, Emory colorectal surgeon Patrick Sullivan, MD, has found the training to be more than valuable. "Until you are in the heat of the moment in a crisis, you really don't know how the team will respond," he says. "A tremendous amount of growth occurs when you are challenged with new scenarios. This type of training is critical to optimizing the best care for our patients, and my colleagues and I feel indebted to Dr. Muret-Wagstaff for initiating CORE."

The CORE Leadership Committee plans to include residents in future training, and is working to secure funding to make this possible. However, the initial and ongoing engagement of faculty in the program is integral to CORE's vision. "Faculty role models are the exemplars that residents and fellows emulate in the operating room. They will always be our mainstay. The faculty also understand that education never ends, and CORE offers them additional opportunities for development and improvement."

CORE documented its post-launch growth over a six month period in a poster that was entered into the 2017 Emory Quality Conference on June 1st. The poster received an Outstanding Education Intervention Award, underscoring the program's potential for becoming a lasting mechanism that enables cycles of learning and performance improvement in operating room emergency response at individual, team, and organizational levels.

In addition to her position at CSAT, Dr. Muret-Wagstaff is vice chair of the Research Committee of the Society for Simulation in Healthcare, associate editor of Simulation in Healthcare, and a member of the Research and Development Committee, Accredited Education Institutes Consortium, sponsored by the American College of Surgeons.

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