1. Malpractice Insurance Incentive for Operating Room Teamwork Training via Simulation Jeffrey B. Cooper, PhD Center for Medical Simulation & Mass. General Hospital Douglas S. Smink, MD, MPH, FACS Neil & Elise Wallace STRATUS Center for Medical Simulation Brigham and Women’s Hospital

2. Program Developers William Berry, MD, MPH Kathy Dwyer, MSN, RN CRICO: Insurer of Harvard Medical Institutions “To provide a superior medical malpractice insurance program to our members, and to assist them in delivering the safest health care in the world”

3. Surgery: High Risk for Claims Technical Errors Communication Failed or lack of response CRICO’s conclusion: Build resilient teams that react promptly, correctly

4. CRICO Team Training Initiatives Anesthesia Obstetrics Emergency Medicine Now Surgery

5. Program Goals 1)Train high risk surgical teams in teamwork via simulation 2)Build infrastructure by developing core faculty at each hospital 3)Improve the culture of safety

6. Organization Pilot at 4 academic centers Full surgical teams Grants for pilot & implementation of full program

7. Overview of the Program Voluntary 10% premium incentive annually for 3 years for participating surgeons Requirements: – 1 st year: team training (4-6 hours) – 2 nd year: OR safety drill – 3 rd year: requirement to be determined

8. Focus of training sessions: – Assertiveness/speaking up – Closed loop communication – Correct utilization of the safe surgery checklist Goals: – Improve teamwork and communication – Improve patient outcomes Training Goals

9. The Scenarios Code outside of OR – Unfamiliar environment levels the field for all participants – Everyone out of their usual roles Hemorrhage Catastrophe in the OR – At the discretion of the institution

10. The BWH Experience 7 teams: – General Surgery – Orthopedics – Hospital leadership Team – 2 surgeons – 2 anesthesiologists – Circulating nurse, scrub tech

11. The Day 7:00 am – Introduction 7:45 – Tour of sim lab and mock OR 8:00 – Case #1 – PACU Code 8:15 – Debrief 9:20 – Case #2 – Hemorrhage 9:50 – Debrief 10:50 – Case #3 – OR catastrophe 11:20 – Debrief 12:00 – Lunch and final discussion

12. Post-simulation Surveys *(1= disagree strongly; 2=disagree slightly; 3=neutral; 4=agree slightly; 5=agree strongly)

13. Change of Practice

14. Communication and Assertiveness

15. Conclusions An insurer-supported, multi-institutional OR team training team training simulation program is feasible with modest compensation for lost operative time The vast majority of participants found the course to have had a meaningful impact on their clinical practice Communication varies by discipline