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Anesthesiologists Jose Rodrigues-Paz (second from right) and Lynette Mark (far right) use SimMan, the lifelike simulator that can be programmed to mimic a real patient's symptoms and complaints.

Simulating Safety
Sophisticated mannequins can help teams prevent future harm to patients.

For years, hospitals have used simulation technology to hone clinicians’ skills for such scenarios as respiratory and cardiac arrests, difficult intubations and births. At Hopkins, teams are also bringing in the same sophisticated mannequins to prepare for complications that may arise when new treatment technologies and methods are adopted.  

For example, the simulator, called SimMan, is used to teach caregivers how to prepare for brachytherapy procedures, in which cancer patients are exposed to radioactive material. The procedure had not been performed here as of 2006 and caregivers had questions about how they would respond to problems that might arise during treatment. It has several risks because caregivers can’t be in the room while the patient is being treated.

So a group, including radiotherapists, anesthesiologists, physicists, surgeons and nurses sets up SimMan in an operating room and practices their responses to complications—irregular heartbeats, cardiac arrests and other problems.

“We needed to simulate it several times before we actually did the procedure on patients,” says David Hunt, Hopkins’ perioperative safety officer. “We wanted to know that we had the right equipment, the right procedures and the teamwork training and preparation should any untoward event occur.”

While practicing their responses to unexpected situations, the group also discovered that cameras needed to be installed in different locations to better track the patient’s condition. To administer medications to patients who were 15 to 20 feet away and separated by a lead door, they installed extra-long tubing and calculated how much fluid was needed to ensure that medication reached the patient. Experts used a Geiger counter to measure the radiation after the device was turned off—and found it was usually eight seconds before they could re-enter the room (although it could be 45 seconds if the brachytherapy equipment malfunctions.)

Because of the delay, teams were sensitized to the need to lower their threshold for stopping the procedure at any given time if they have concerns, Hunt says.

So far, the preparation has paid off. Anesthesiologist Jose Rodriguez-Paz, who programs the simulator, says there have been a couple of cases in which patients had unexpected problems during treatment. “But everyone knew what to do and how to do it.”