Departmental use of perfusion crisis management drills: 2002 survey results

Abstract

Serious complications during the performance of cardiopulmonary bypass (CPB) are an infrequent event. However, when potentially fatal technical complications, such as oxygenator or pump failure, do occur, it necessitates a swift and well-co-ordinated response. Periodic performances of drills that simulate various CPB crises are a way to improve individual perfusionist proficiency during disaster situations. The purpose of this study is to determine the utilization of crisis management drills in perfusion departments. Every open-heart program listed by the American Hospital Association in the New England states (Maine, Massachusetts, Rhode Island, Vermont, New Hampshire, Connecticut) and New York were contacted by telephone. Of the 61 contacted, 59 participated for a response rate of 97%. Demographically, the survey represents 312 perfusionists and 47 227 cases annually. While 97% of the perfusion departments believed that regular practice and performance of crisis management drills would improve individual proficiency, only 17% of the programs mandated that their perfusionists perform crisis management drills as a matter of departmental policy. Reasons expressed for not having a formal written policy regarding performance crisis management drills were as follows: left up to the individuals to maintain proficiency 19 (39%), not motivated 11 (22%), confident of proficiency 9 (19%), no time 8 (17%), dubious value 1 (2%), and cost prohibitive 1 (2%). While it is nearly universally accepted that periodically practicing perfusion crisis management drills in a 'wet lab' environment would improve proficiency, only a minority of perfusion teams deem this a high enough priority to make it a matter of formal departmental policy.

Patient Safety in the Cardiac Operating Room: Human Factors and Teamwork

“…252,257 Virtually 100% of perfusionists surveyed in 2002 believed that such practice would be beneficial, but only 17% reported that such drills occur. 258 In a recent study of education of whole cardiac surgery teams in crisis management using high-fidelity simulation, participants reported 2 areas of highest priority and improvement: encouraging outspokenness about critical information and improved interprofessional communication by clearly defining the intended recipient (using the name of the person to whom communication is directed) and by attention to "closing the loop" in verbal communications. 259…”

Simulation in perfusion: evaluating the efficacy of a specific training with eye-tracking

“…A Japanese research group showed in several studies [8][9][10] that by practising on a simulator, subjects were able to maintain patient values (blood flow rate and reservoir level) closer to a predetermined level than without practise. Ginther et al 11 tested simulation training in the context of critical situations. In a study with their own students, they showed that mentally going through a sequence of actions (exchanging the oxygenator) before putting it into practise resulted in a 20% faster execution than none at all.…”

Perfusion safety: new initiatives and enduring principles

“…Simulators have also become popular at perfusion meetings for staging drills to practice oxygenator change-out or other CPB emergencies.While perfusion simulators are intriguing and their use is gaining popularity, any perfusion team can perform drills using existing CPB equipment. However, while respondents to a survey 85 indicated the widespread belief that practice and crisis management drills were appropriate, only 17% reported their team members actually performed drills as a matter of departmental policy. Such findings were reconfirmed recently by Darling and Searles.…”