Patient safety initiatives are increasingly directed at improving both the individual and collective skills of teams of health care professionals. The Institute of Medicine estimates that poor communication among health care professionals is a major source of those errors. In an effort to increase patient safety, several centers around the country are using simulators to train physicians to more effectively care for patients.
The Wood and Clinical Simulation Centers at Washington University School of Medicine have been the recipients of several grants funded by the federal Agency for Healthcare Research and Quality (AHRQ) of the Department of Health and Human Services — that hopes to improve patient safety by designing more effective training and assessment strategies using simulation. This simulation-based research is used to establish practice and competence standards for physician skills that are directly applicable to patient care.
These grant projects included:
- Acute Care Management Skills: An Assessment Program for Graduate Physicians
- Teamwork, Communication and Decision-Making: As Assessment Program Using Simulation
- Critical Care Skills: Simulation to Assess Decision-Making Skills
The goal of the research is to gain insight into the common causes of communication failures, and ultimately to bring significant changes to the practice of medicine that will improve patient safety.
David Murray, MD, the Carol B. and Jerome T. Loeb Professor of Medicine, and his colleagues have been using simulators to help assess and improve physician competence for more than 20 years.
Other research areas
Murray and other faculty members in the School of Medicine’s simulation programs have published a number of scientific articles on topics such as setting standards for mannequin-based acute-care scenarios and whether an inventory of simulated intra-operative scenarios provides a reliable measure of anesthesia residents’ and anesthesiologists’ skill.
Murray DJ, Boulet J, Ziv A, Kras J, McAllister JD, Woodhouse J: An Acute Care Skills Evaluation for Graduating Medical Students: A Pilot Study Using Clinical Simulation. Medical Education 36: 833-841, 2002
Boulet JR, Murray DJ, Kras J, Woodhouse J, McAllister JD, Ziv A: Reliability and Validity of a Simulationbased Acute Care Skills Assessment for Medical Students and Residents. Anesthesiology 99: 1270-1280, 2003
Murray DJ, Boulet JR, Kras JD, Woodhouse J, Cox T, McAllister JD: Anesthesia Acute Care Skills: A Simulation-Based Anesthesia Skills Assessment. Anesthesiology 101: 1084-95, 2004
Murray DJ, Boulet JR, Kras JD, Cox T, McAllister JD. A Simulation-based Acute Skills Performance Assessment for Anesthesia Training, Anesth Analg l01; 1127-1134, 2005
Murray DJ, Boulet JR, Avidan M, Kras JF, Henrichs B, Woodhouse J, Evers AS. Performance of Residents and Anesthesiologists in a Simulation-Based Skill Assessment. Anesthesiology 107: 705-713, 2007.
Boulet JR, Murray DJ, Kras JF, Woodhouse J. Setting Performance Standards for Mannequin-Based Acute-Care Scenarios: An Examinee Centered Approach. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare. 3; 72-81, 2008.
Kuhrik NS, Kuhrik M, Rimkus CF, Tecu NJ, Woodhouse, JA. Using Human Simulation in the Oncology Clincal Practice Setting. J Contin Educ Nurs 39(8); 345-355, 2008.
Henrichs B, Avidan M, Murray DJ, Boulet JR, Kras JF, Evers AS. Performance of Certified Registered Nurse Anesthetists and Anesthesiologists in a Simulation-Based Skills Assessment. Anesth Analg 108:255-262, 2009.
Waldrop WB, Murray DJ, Boulet JR, Kras JF. Simulation-based Assessment of Residents’ Skill in Managing Anesthesia Equipment Failure. Anesth Analg 2009; 109, 426-33.
Hamilton, N, Freeman BD, Woodhouse J, Ridley C, Murray D, Klingensmith ME. Team function during trauma resuscitation: A simulation-based performance assessment. Journal of Graduate Medical Education JGME 1: 253-9, 2009.
Duncan JR, Henderson, K, Street, M, RichmondA, Klingensmith, M, Vannucci, A, Murray DJ. Creating and Evaluating A Data-Driven Curriculum for Central Venous Access Journal of Graduate Medical Education JGME 2: 389-397, 2010.
McBride ME, Waldrop WB, Fehr JJ, Boulet JR, Murray DJ. Simulation in Pediatrics: The Reliability and Validity of a Multi-Scenario Assessment. Pediatrics 2011:128; 335-343.
Fehr,JJ, Boulet JR, Waldrop WB, Snider R, Brockel M, Murray DJ. Simulation-based
Assessment of Pediatric Anesthesia Skills. Anesthesiology 115:1308-15, 2011.
Hamilton NA, Kleninger AN, Woodhouse J, Freeman BD, Murray D, Klingensmith ME. Video Review using a reliable evaluation metric improves team function in high-fidelity simulated trauma resuscitation. J Surg Educ 69: 428-31, 2012.
Fehr JJ, Honkanen A, Murray DJ. Simulation in pediatric anesthesiology. Paediatr Anaesth.22:988-94, 2012
Burns T, DeBaun M, Murray G, Murray D, Boulet J, Fehr J. Acute Care of Pediatric Patients with Sickle Cell Disease: A Simulation-based Performance Assessment. Pediatr Blood Cancer 60:1492-8, 2013.
Murray DJ, Freeman BD, Boulet JR, Woodhouse J, Fehr JJ. Decision-Making in Trauma Settings: Simulation to Improve Diagnostic Skills. Simulation in Health Care 10: 139-145, 2015.
Fehr JJ, Shepard M, McBride ME, Mehegan M, Reddy K, Murray DJ, Boulet JR. Simulation-Based Assessment of ECMO Clinical Specialists. Simulation in Health Care 11: 194-9, 2016.
Juriga L, Murray DJ, Boulet JR, Fehr JJ. Simulation and the Diagnostic Process: A Pilot Study of Trauma and Rapid Response Teams. Diagnosis 4: 241-9, 2017.
Boyle WA, Murray DJ, Beyatte MB, Knittel JG, Kerby PW, Boulet JR. Simulation-based Assessment of Critical Care ‘Front-Line’ Providers. Crit Care Med 46: e516-e522; 2018.
Murray DJ, Boyle WA, Beyatte MB, Knittel JG, Kerby PW, Woodhouse J Boulet JR. Decision-making skills improve with critical care training: Using simulation to measure progress. Journal of Critical Care 47: 133-138; 2018.