“Systemness” in Emergency Medicine at UH
March 25, 2021
CME simulation sessions at UH community hospitals improving quality in real time
UH Clinical Update | March 2021
Can you take a lesson learned in one specific case and location and spread the knowledge throughout the entire UH system? The Emergency Medicine Quality Network (EMQN) at UH is determined to try. They’re converting findings from their quality reviews into team training simulations of challenging procedures, offered once a quarter at every UH community hospital. Thanks to a generous donation from UH emergency medicine physician Howard Dickey-White, MD, the team is taking its show on the road, complete with a van, mannequins, central line trainers, airway equipment for ED physicians, nurses and APPs to practice on and more.
Riley Grosso, MD, Director of Quality and Peer Review for the Department of Emergency Medicine at UH Cleveland Medical Center, recently led such a team training simulation at UH Bedford Medical Center. The topic was difficult airway and angioedema, and the simulation was fiberoptic intubation. It was a scenario an ED physician is almost guaranteed to see, she says.
“We have a large population of patients who are on lisinopril, which causes really bad angioedema as a side effect,” she says. “We have a lot of patients on it in our community, and that is the most common use of this fiberoptic technique. It’s not an uncommon disease process.”
The group training at UH Bedford engaged in some specific lessons on teamwork and then ran the fiberoptic intubation scenario, with extra time afterward for the participants to get more experience with the simulation equipment.
It didn’t take long to pay off: An ED physician at UH Bedford used what he learned the very next day. A woman presented in the ED with a severe oral abscess and impending failed airway, but he was able to avoid a surgical airway with fiberoptic nasotracheal intubation.
“This was a great save,” says Jessica Goldstein, MD, Medical Director for the Emergency Medicine Quality Network. “Fiberoptic intubation is our first system simulation based on needs identified through risk and quality review. The training has already translated into at least two airways emergency medicine providers have saved from requiring surgical airways.”
“This is outstanding training content,” adds Christopher N. Miller, MD, an emergency medicine physician and President of the UH Clinical Network. “It’s an absolute game-changer for patient safety, quality and outcomes.”
Key to the success of this training and quality effort, Dr. Grosso says, is the emphasis on simulation.
“You can watch YouTube videos and read PowerPoints, but until you get your hands on the equipment and actually practice, it’s not the same,” she says. “Also, adult learners learn by doing. We get to adult learners and teach them like adults and contextualize it by saying this is a patient you will see and have seen.”
The simulation training team will next tackle sepsis resuscitation and central line placement. With these and other simulations, the goal is continuous improvement, consistency and standardization across the UH system, Dr. Goldstein says.
“It’s an example of having a commitment to improve continuously as part of an enhanced learning system, which is going on a lot in our system right now,” she says. “How do we learn from a risk that was identified at one location and share that knowledge across our service line at UH, which is the EMQN, and then how do we share that type of learning in a vertical framework with others?”
This approach will not be unique to Emergency Medicine, she predicts.
“We’re starting with emergency medicine, but there’s the potential for this type of simulation to translate to other disciplines as part of UH’s progress towards having a process for clinical knowledge translation,” she says. “We learn from an event and then translate that into knowledge across our system.”