‘Ahead of the curve’: Michigan Medicine a national leader in cardiovascular training, simulation
Michigan Medicine recently received recognition from the American Board of Cardiovascular Perfusion (ABCP) as a high-fidelity perfusion simulation center.
Perfusion technology is used in the operating room to provide cardiopulmonary support, or take over for the heart and lungs of patients undergoing cardiac bypass procedures. A perfusion machine pumps blood as the heart normally would, providing nutrients to tissue throughout the body. The machine also performs the gas exchange that is a normal function of the lungs.
Perfusion simulation allows residents, nurses, surgeons and anesthesiologists to practice on a bypass circuit without a real patient involved. Scenarios are created to teach team members how to respond in routine and high-risk, low-frequency situations.
“The high-risk situations we practice don’t happen often, so learners and practitioners have little exposure to them,” said David Sturmer, C.C.P., Michigan Medicine’s chief of perfusion. “Due to the catastrophic potential when they do occur, it’s essential that they are handled effectively in order to prevent serious harm to the patient.”
Little time to act
Examples of scenarios that are practiced within the perfusion simulation center include mechanical failure of the pump, which has the same impact on a patient as cardiac arrest, and failure of the oxygenator, which has the same impact as a patient’s lungs ceasing to work.
In both of these scenarios — as with a heart attack or respiratory failure — the team in the OR has only four to six minutes to correct the situation in order to avoid a devastating outcome for the patient. This is especially challenging during a cardiac procedure because the team does not have the ability to use CPR, which would be the first step if someone were experiencing cardiac arrest outside of the OR.
Why is perfusion simulation important?
“As technology has advanced with perfusion equipment, patient safety has increased,” said Sturmer. “But there is still the potential for high-risk events to occur, and our ultimate goal is to prepare OR teams so they are equipped to respond if they do.”
Anna Watterworth, M.S., B.S.N., R.N., perioperative cardiac surgery nurse specialist, agreed. Watterworth spends a lot of time using simulation to train nurses and surgical technologists in the cardiac operating rooms.
“It is so important to prepare learners for the clinical environment through simulation,” she said. “The types of cardiac cases we do here no longer provide a conducive learning environment for a traditional, strictly clinical training format. Simulation gives our staff the opportunity to practice technical skills, make mistakes and fail in a safe space without a direct impact to the safety of our surgical patients.”
Greg MacLean, C.C.P., clinical perfusionist, was largely responsible for putting together the application that earned Michigan Medicine the ABCP recognition.
“Simulation in health care has often been overlooked,” said MacLean, “but it should be a regular part of training. Teaching people how to communicate and work together in life-like scenarios is critical and avoids the potential for real-life emergency situations.”
According to Sturmer, Watterworth and MacLean, creating a realistic environment is key.
“We want the simulation to be as realistic as possible — so real that people respond emotionally, just as they would in an actual case,” said Sturmer.
The team also shared that it’s important to encourage communication during simulation and create a team environment where barriers are broken down, collaboration is encouraged, everyone is actively engaged and each team member feels free to ask questions about what’s happening.
What does ABCP recognition mean?
“Michigan Medicine has an accredited clinical simulation center run by Dr. James Cooke,” said Sturmer. “This ABCP recognition dovetails into that, allowing us to offer case credit for certified perfusionists who participate in a simulation event as part of the recertification process. The fact that we were approved by ABCP means we are operating at a level high enough to create a realistic, high-fidelity clinical experience.”
In addition to benefiting learners and perfusionists at Michigan Medicine, the ABCP recognition will help to create broad awareness about the organization’s program.
“Michigan Medicine is one of only 10 simulation centers in the country to have achieved this recognition,” said MacLean. “As a pilot program, we want to draw interest within the perfusion community and this will help get our name out there. This is a real stepping stone to growing our program, improving processes and increasing patient safety.”
Leading the way
The complexity of the cases at Michigan Medicine is very high. Although the majority of other cardiac centers in the state perform bypass and valve replacement procedures, Michigan Medicine sees a different case load and has a need to train staff how to handle such complex patients.
Although perfusion simulation is currently limited to Michigan Medicine faculty, staff and learners, the goal is to eventually invite medical professionals from other organizations to learn in the sim center. In fact, the perfusion team would like to offer opportunities to all 33 heart centers in the state that are part of the Michigan Society of Thoracic and Cardiovascular Surgeons.
“The university is extremely dedicated to this work and the education provided through simulation,” Sturmer said. “It’s part of our plan to reduce risk and potential injury, both here at Michigan Medicine and elsewhere.”
Sturmer pointed out that there are only four organizations in the country doing simulation work at a level similar to Michigan Medicine.
“It’s pretty cool that we’re even doing this,” he said. “This is the direction medical education is evolving, and we are ahead of the curve. We need to keep moving and stay there.”