2/18/2015 ASDIN SIMULATION AND TRAINING IN DIALYSIS ACCESS HUMAN FACTORS AND PATIENTS SAFETY

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1 SIMULATION AND TRAINING IN DIALYSIS ACCESS HUMAN FACTORS AND PATIENTS SAFETY ASDIN 11 TH ANNUAL MEETING ORLANDO, FEBRUARY 15, 2015 INGEMAR DAVIDSON DALLAS, TEXAS M.K. Widmer, I. Davidson. Simulation training to improve the skills of the vascular access surgeon. Davidson I, Widmer M.K. Team training in the OR to establish a safety culture Slakey D, Davidson I. Patient Safety in Peritoneal Dialysis drd@ingemardavidson.com Deaths per 100 Million Hours Overall Risk of Dying/Year 1/130 (0.9%) MVA 1/7,000 GSW 1/10,000 Heart Disease 1/400 Cancer 1/600 Being Pregnant 1 Traveling by Train 5 Working at Home 8 Driving Your Car 50 Construction Worker 67 Commercial Airlines 100 Being Hospitalized 2000 Falling 1/20,000 Poison 1/40,000 Pedestrian 1/60,000 Drowning 1/75,000 House Fire 1/100,000 Biking 1/500,000 Plane Crash 1/30,000,000 Lightning Strike 1/3,000,000 Stroke 1/2,000 Pneumonia 1/3,000 Dialysis 1/5 Bad Access 1/20 Kidney Transplant 1/20 Shark Attack 1/100,000,000 Anthrax 1/500,000,000 Living Kidney Donor 1/3,300 Navy Nuclear Aviation Air Traffic Control Health Care /Access CHARACTERISTICS 1. Complex 2. Dynamic 3. High peak demand 4. Intensely Interactive 5. Low incidence of Failure INDIVIDUAL ( Sharp end ) Fear Disciplinary Action Litigation Retraining, More CME Blame Shame SYSTEM ( Blunt end ) Why Barriers Failed Just Culture Accountability Learn from Mistakes Anonymously Reporting Team Training ASDIN

2 Widely accepted Global standards for Cockpit behavior and Cooperation Unmatched Aviation level of Safety CRM after Tenerife Accident (540 died) 1. Simulation Training 2. Checklists, Briefing, Debriefing 3. Communication, Phraseology 4. Anonymous reporting of mistakes Kidney Transplant Four Immunosuppressant Drugs 1. Alone or in combination 2. Dose 3. Time of onset 4. Duration Dialysis Access > 27 access Surgical Sites > 20 Patient variables : Age, diagnosis, smoker, CVD, vascular anatomy, social history, eyesight, etc. 128 Treatment Regimens >300 Surgical Treatment Options Flights (Millions Annually) Crashes/ M Takeoffs 2006 Fatalities/ M Passengers 2007 Africa Middle East Latin America Asia Europe North America World Dialysis Access > 27 access Surgical Sites > 20 Patient variables : Age, diagnosis, smoker, CVD, vascular anatomy, social history, eyesight, etc. 20 Surgical Sites/25 Patient Variables = 300 Options History & Physical Exam Blink = 5 Options 300 Surgical Treatment Options Confirm with Ultrasound = 1-2 Workable Solutions (One of which should be PD) ASDIN

3 CENTER % STENOSIS Three Training Components for Professional Success There is no substitute for knowledge and skills A 6 Percent Graft Function at 12 Months B 16 C 21 D 25 E 35 F 39 G 46 Total 28 10% 2. Skill How to Do Simulation Experience 1. Knowledge What to Do, Why to Do Schooling 10% 100 % Professional Effectiveness Success 80 % 3. Human Factor Attitude Want to Do Communication Regulations 3. CRM-HF-Culture (Aviation) Crew resource management (CRM) Human Factor (HF) Human System Interaction Attitude Social Intelligence (SI) Situation awareness (SA) Communication skills Root Cause Analysis (RCA) Anonymous Reporting Learn from Mistakes Attitude Affects safety and effectiveness. Greater impact than facts, your past, education, failures and success, Including Knowledge and Skills. Attitude can break a company, an association, a church and a family. We can choose what attitude we embrace every moment. We cannot change the past or peoples actions. Life is 10% of what happens to us and 90 % how we react to it. Low WAR Destructiveness Obstruction Lose/Lose (Lawsuits) Trust Lying High Low Effectiveness Respectful Compromise Low Win/Win Defensive Win/Lose Synergize Win/Win Cooperation Trust Level High Words we use Tone of Voice Body language Face reading It s about being safe How to say NO Delivering Bad News Make your own checklists fitting your hospital, geography, state, or country Airlines have checklists for types of airplanes and airports Improves Safety ASDIN

4 Reinforces Embarrasses Discourages Punishes Thanks for backing me up. I didn t know you were an instructor? I heard you the first time. I m already aware of it. Don t you think I know my job? 1. Neck IJ Dialysis Catheters 2. US Vascular Mapping 3. Dialysis Access Cannulation 4. The Peritoneal Cockpit 5. Computer Arm Simulation 6. Anastomoses Suture Lab 7. Tools in Access Surgery 8. Human Factor. J Vasc Access Vol 15 Suppl 8, 2014 EDUTAINMENT ASDIN

5 Tier 1 - Minimal dialysis access experience (up to 4 weeks training) Dr. A Frederick Schild Dr. Alexander Yevzlin Dr. Gerald Beathard Dr. Ari Kramer Dr. Sanford Altman Dr. John Lucas III Tier 2 - Several Years of access experience - one week of refreshing Tier 3 - Training to Instructor level Dr. Larry Sher Dr. Bart Dolmatch Dr. Earl Schuman Dr. Jeff Hoggard Dr. Jack Work Dr. Thomas Vesely J Vasc Access Vol 15 Suppl 8, 2014 Dr. Marc Glickman Dr. MitchellHenry Dr. Charmaine Lok Dr. Jeffery Lawson Dr. Lawrence Spergel Dr. Jamie Ross ASDIN: TaCiDA Website: Dr. Davidson s Website: Dr. Ross' Website: CiDA / SoDA Website: The J Vasc Access: The VASA website: The VAS Europe website : The Japanese Society for Dialysis Access: Vascular Access Society of Britain and Ireland J Vasc Access Vol 15 Suppl 8, 2014 Healthcare is Complex 1. Complex Systems 2. Systems of systems (Global) 3. Left alone (Cutting Corners) 4. Wisely Manage (Predict outcome) 5. Hire Safety Engineers! 6. Administration (Blunt end) Drifting or Fluid 1. Drift into Success or Failure 2. Interdependent Mindset 3. Drift into Failure 4. Drift into Success 5. Like the Airlines 6. Real people (Sharp end) The Forum on Dialysis Access Nephrologists, Surgeons and Radiologists HIGHLIGHTS SoDA, Dialysis Access Simulation Central Vein Obstruction Peritoneal Dialysis Placement and Management Hemodialysis Endovascular and Surgical Lessons Learned the Hard Way Percutaneous and Immature AVFs Outpatient Access Intervention New Orleans, LA October 28-30, 2015 dialysiscontroversies.org ASDIN

6 New Orleans, October 28-30, 2015 ASDIN