When Mistakes Are OK

Mayo Clinic's simulation centers replicate reality to prepare caregivers for any situation

By Mayo Clinic Staff

Code Blue is as serious as it gets in a hospital. A patient is in cardiac or respiratory arrest and needs immediate, lifesaving care.

The team of doctors, nurses and other personnel must make split-second decisions while racing to perform CPR, start IVs and hook up monitors.

Despite what we see on television, Code Blue is fairly uncommon, with most hospitals averaging one a month. Yet, when only 15 percent of patients survive a cardiac Code Blue nationwide, practice can mean the difference between life and death.

"You can read that stuff all day in a book, but until you have to do it in the moment, you don't really know it," says internal medicine resident William C. Palmer, M.D., who knew his skills were up to snuff during one harrowing night in the hospital at Mayo Clinic in Florida.

He and his team faced four cardiac arrest Code Blues with three patients. They administered nearly 15,000 chest compressions, three airway intubations and 14 heart shock treatments.

The team saved every patient. He credits the success to simulation training.

"The mock code simulation courses have made our codes drastically more efficient and organized," Dr. Palmer says.

Safe to make mistakes

Today's simulation education is stunningly realistic.

Mayo Clinic's simulation centers are filled with rooms that are exact replicas of clinical spaces — operating rooms, intensive care units, emergency departments and even patient rooms.

Some "patients" are advanced mannequins that talk, sweat, bleed, change pupil size and exhibit medical symptoms that may occur with a variety of conditions, from heart trouble to dehydration. Other patients are trained actors who work with staff to accurately portray scenarios. State-of-the-art technology simulates robotic surgery, colonoscopy, complex laparoscopic surgery, ultrasound, fluoroscopy and other imaging techniques.

The lifelike environment allows staff members to rehearse again and again, to make mistakes in a safe environment. Without ever talking with a patient, they can gain experience with the most complicated scenarios, such as four Code Blues in one night.

"In our simulation center, we can replicate any scenario or situation you can imagine," says David D. Thiel, M.D., medical director of Florida's new J. Wayne and Delores Barr Weaver Simulation Center. The facility can link with Mayo's other two simulation training centers in Minnesota and Arizona to efficiently run drills that impact all three sites.

However, despite medical simulation's ability to help surgeons, nurses and housekeepers become better and faster, no grants or industry sources of funding are available. Mayo Clinic partners with generous benefactors to integrate simulation into its medical education.

"Simulation provides an environment where we can push ourselves in complicated cases and practice so we minimize risk for the patient," Dr. Palmer says.

May 09, 2014