Making Major Strides in Improving Patient Safety Physicians and scientists, especially at academic medi ­

cal cemers, have made dramalic strides in treating and

preventing disease. However, patiem safery in the U.S.

continues to be jeopardized by medical errors thar can

lead to death or severe inj ury to as many as 100,000

pari nts annually-not to mention "near misses" in

which tragic consequences are narrowly avoided.

At the University of Miami Miller School of Mcdicine­

Jackson Memorial Hospital Center for Patient afery

(CPS), we provide a comprehensive approach to pre­

venting medical errors and improving patient safety.

OUR MISSION IS TO BUILD SAFER HEALTHCARE BY:

• Harnessing t he power

of simulat ion t o enhance

medical educati on and

prevent pat ient harm

• Discovering pathways

t o ensure patient sa fety

through innovative research

• Becoming a lead ing resource

for designing safer hospitals

and hea lthcare facilities

AComprehensive Approach to Meet a Complex Challenge

lomenrary misjlldgm ents, uncl ea r orders. and

avoidable i nfe cl ions all represent medical errors

that can compromise pa tient sa~ ly.

To effective! address these complex challenges,

the UM-JMH Cemcr for Parient S,lfclY wo rb

to impro e p:ltiem safery in the fo llowing areas

of vulnerability:

• Bedside procedures • om[11\ll1ication .1nd reamwor

• Crisis managemem • Safe use of diagnostit: and (hemp 'u tic

technologies

• Hand hygiene

• Order writ ing • Pa tient confidentialiry

r hesc srraregi s to protect p:llicnL~ have also

been succes -ful ly incorporated inco cd ationa l

programs ~ r practicing prore~s i mals r:1l)ging (rom

ill - h o~pi lal lcams and emergency responders to

ph,trmacisls and risk managers .

CPS progra ms have been integrated in to the

training of phYSicians and nurses in almost all

Debr ipilng sessions, iI k Y omponent of ol lT1Ulillion education, allow trainees lo reflect on,s are, and learn from their experiences.

spt::cialties, incl uding anesthesiology, cmt'fgt::ncy

meuicine, intern,ll medicrnc. military medicine,

rilic.]1 care, ohstct rics and gynecology, fort::n~iL

scicl ceo and pediatrics.

CPS coIlahnr:nes with qllaliry. r i ~k t1Ianagement,

anJ 'ducational team ' throughout the Ulllv{'rsily

of Miami and Jackson Health Systcm~ . As Il t::w

cbllcngcs are iJenuf1eJ, we.: work to find solurions

leading to cont in ued improvement in the care an d

safery of r,1tie nl~ .

Maximizing the Potential of Simulation-Based Education

T he cornerstone of the UM-JM11 Cen ter for

Patient Safety curr iculum is simulation-based

ducatiol1-a powerfu l ap proach that allows

trainees to r<.::st and hone their abilities in scenarios

that range fro m ro utine exams to medical

el 1 rgencies . ore than 20 CPS train ing programs

blend simula tion wi th didactic education , case

review and discussion, standa rdized patients, and

othcr lechniq u s and tools thJr reinft rce key

concepts while strengthening skills.

1 he center's 8,OOO-square- foo t facility comp rises

mo re than 2,000 quare feet of spacc d dicated to

simula tion-based traini ng aCli\'itit;:s and rest:arcrl.

Simulatio n labs replicate parient ca r st:tting'

such as an operaring

room, em~rgency roOtl1.

intensive care unir ,

radiology su ite, hosp ita l

patient roo m, cardiac

cHheteri/Jtion lab, and

amhularory cl inic.

W ithin o ur simulation fac il ities, as m any as six

pa ti ent simul. r"ors can be used simul taneously.

A nursing trainee gains hJnds-o~ experience in critical care Wi th a l1igl -fidelity ~imu la tor.

The sim lll· ro rs may be conrroUed from the

bedside Fo r info rm I teaching or Irom the

center's control room for full -scale, team-hased

. im ulations . The comrol roo m also includes

ideo and aud io production <.::quip mcnl and

softwJre to create materia ls for off-site learni ng.

O ur ex p n use of these technologies enmrcs that

the educatio nal potencia l of everyone of OlJr

traini ng aeri 'ities is uti lized ro the fullest.

Implementing Insights at Every Stage of Care

The UM-JMH Cenrer ror Patienr Safery add r ses

pat ient sa rery issues through a varicry of proj cccs

nlJ1 ded by both governmen tal agencies on dle

state and federa l levels and by private sources.

IT ey areas include:

Hospital redesign: According to the InslirlJ[e of

Medicine. Haws in the layout of hea lthcarc cil ities

comribure 10 mt:dical errors. CPS uses unique

si mulation rne l horl~ ro cvaIUlI[t: des igm fo r satery

rea tures prior co construction or renovatio n.

Hospital-acquired infection (HAl): Hand hygiene is

the single most effeetive measure for red ucing

hospi Lal -acquired

infcLl ions, which I ill

thousands of p;ltients

c;lch year. The hand

hygiene program

developed by the

cenrer includes an

educational. fil m, slide presentations, ski lls (esLing.

and l on~-lerm monitOri ng. T he cene r has als cre­

atcd a Web-hased e-lea n i ng program to help d is­

seminate hand hygiene awareness and skills.

A key target at patien t ~afety training i, inlectlons caused by biJctert ii hat may be transmitted (dbove) ill vanoll '; sfte~ in <'l hospital room or (left) on con tamillated !lands

Reporting near misses: Narrowl ! Jvoided medical

errors can provide extremely useful clues co

improving hea lthcarc rraining and pracuee. The

center is developtng volu ntary. Web-based data

collection and analys i, tools to gather and evaluare

near misses in hospi tals aud ,urgical ,In ri birthing

cenrers throughout Flot·ida.

Expert Leadership to Advance the Field

David]. Bim bach, MD ., M.r~H ., direcror of the

Center for Parienc Safety, bri ll a wealm of knowledge

and expertise to the field of patienc safety. O ur team

includ s physicians, nurses, a simulation engineer, and

administrative suppon staff. Instructors from every

clinical depanmem on campus collaborate wim LIS to

develop specialry- pecific training programs.

[n add ition, the cem er nas a video production

expert on staff, enabling o ur team to create

training ideas dramatizing medical scenarios.

CPS faculry and staff also work closely with experts

at schools and colleges within the niversity of M iami

as well as with other academic institutions. Our

relationship' v itl l Professor Eduardo Salas, Ph. D .,

a world-renowned teamwork expert at the University

of Cenrral florida in O rlando, and Captain W dliam

Rutherford, M .D ., a United Airlines simulation e pert

who now teaches at Western Michigan Universiry, have

produced several highly-productive, ongoing colhbora­

tions. In addition, Paul C luck, M.D., the past chair of rhe

acional Patient Safery Foundation Board of Dircccors,

ha, recently joined d1e Center for Pariem Safery team

and will enh<wce our narional and international efforts.

Led by DaVid J Birnbach, M D , M PH {above left}, the CPS team includes (above right) assoc.iate director Joshua Lenmus, D O , R.Ph., FA C.P (Below) key strategy utilized by CPS to minimize medical errors is root c use analysis, here bemg taught to medical residents at Jackson Memortal Hospital .

.1Health UNVERSITV Of MIAMI HEAlTH SYSTEM

MILLER SCHOOL OF MEDICJNE

UNIVERSITY OF MIAMl

Jackson HEALTH ~Y~TF.M