The Human Factor Group

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Ch. Harms MD.
(Managing director of
TOMS)

In Basel we build up an entire operation-theater-simulator . As in reality this OR is fully equipped as well with all the surgical facilities (e.g. clothing, surgical instruments, video assists) aswith the anesthesia equipment (e.g. medicaments, IV's,tubes, ventilator). The simulator mannequin, nick named ' Wilhelm Tell ' is a commercially available resuscitation dummy with several 'ads on', developed by our group. It allows a full patient monitoring (e.g.ECG, saturation, NIBP,art.-BP, CV- and urine-output-monitoring),tracheal intubation and the auscultation of breath sounds and heart beats. Simulation is controlled by a computer system with physiologic and multiple compartment pharmacokinetik and pharmacodynamic models (developed by the SOPHUS-Group in Denmark) running on standard software. The simulator complex is equipped to provide real time video recording. On the videotapes all vital parameters are simultaneously displayed in a 'blue window'.

In accordance with our goal mentioned above, the objective of each simulator session is not simply to reinforce adherence to recognized protocols by the anesthetist or surgeon, in presenting them with multiple problems. Rather we intend to improve the overall performance of the Operating Room team, by providing training in human factors, specifically those interpersonal skills which are of demonstrated critical importance in team work, e.g. maintaining situational awareness, decision-making, and resolving conflicts. We would like to stress the point, that we perform Team Oriented Medical Simulation (TOMS) in which all personnel in the Operating Theater (anesthetic consultant, anesthetic resident,
anesthetic nurse, surgical consultant, surgical resident, scrub nurse and Theater orderly) interact in their normal roles. No actors are involved to supply any member usually working in the Operating Theater.

All staff in the Theater participate in preoperative briefing, intraoperative management of a "scripted" patient, and postoperative debriefing, when the videos are replayed. The goal of each session is to introduce specific behaviors which facilitate workload management, problem-solving and decision-making. Session have demonstrated failures by team members to achieve communication and understanding of the patient's situation.

Up to now 164 persons from the Department of Surgery and 127 from the Department of Anesthesia participated in 50 simulation sessions. We have performed three operations: laparoscopic paraaortal lymphadenektomy, laparoscopic cholecystectomy and a tibia ostheosynthesis. We actually develop a laparoscopic aortic graft implantation.

Basel, Aug 1997