1. Simulation in Cardiac Surgery
Jody Stafford
University Hospital of Wales, Cardiff
I’m here to talk to you about our experience in designing and running a multi-disciplinary cardiac surgery simulation course.
We believe that this is the first course of its kind in the UK.

2. Aim:
Briefly introduce Cardiff’s experience of simulation education
Objectives:
Discuss our experience delivering a simulation study day
Generate discussion -
Is simulation the way forward?
Should we be collaborating more to improve education?

3. Perfusion safety Things can go wrong....
Defective or malfunctioning equipment or supplies
Communication failure between healthcare professionals
Human Error
Failure to anticipate adverse events
Fortunately that advances in Perfusion equipment mean that equipment malfunction is rare. This does mean that Perfusionists that are relatively new wo’nt have seen many emergency situations.
Early communication – may result in earlier intervention
Preparation!!!!

4. Cardiac Surgery Simulation
Critical incidents are extremely rare however they have the potential to be catastrophic!
Simulation provides a safe environment to practice
Simulation has always been used in Perfusion
- change outs/ wet lab practice
Deliver a study day that alllowed the whole TEAM to practice emergency situations
Pumping a glove or bucket is still a really good way to do simulation for Perfusionists, it doesn’t need to be all about fancy equipment.
Historically these practice sessions and change outs are done in isolation, we wanted to deliver a study day that allowed the whole team to practice when things go wrong

5. In order to create high-functioning teams, it is necessary to provide opportunities and facilities in which groups of healthcare practitioners can develop their team working practices. p.24

7. Why did we design this course?
Improve patient care
Develop our team
- Educate
- Improve confidence
- Develop teamwork
We collaborated with Bristol Perfusion department to hire the Orpheus simulator. Perfusionists from cardiff worked with Will, Dave and Dan who are experienced in delivering simulation. This collaboration enabled us to provide high fidelity simulation in Cardiff .
We wanted this course to be free to attend and to include candidates from all roles within the cardiac surgery team.
Huge faculty involved (7 Perfusionists!). Very important to have leads from all professions to advise when designing the scenarios + participate in workshops and debriefing

8. Cardiac Surgery Simulation
A simulated theatre environment offers training of technical and non-technical skills for the whole surgical team.
Fortunate to have a simulation suite in Cardiff. Providing a realistic environment where all staff groups can participate in their normal roles was crucial.
Teamwork
Communication
Situational awareness
Decision making
Leadership
Task management
. This simulator is extremely realistic; it allows the surgeons to cannulate the heart, connect it to the bypass machine and for the patients parameters to change as they would in real life.
. Cardiac surgery simulators are expensive to buy so we collaborated with a local trust and hired one from Bristol Simulation Centre.

10. Non-Technical Skills Teamwork Communication Situational awareness
Decision making
Leadership
Task management

11. Designing the Course Structure:
Workshops, Lectures, High Fidelity Simulation
Candidates
Trainee Surgeons (13)
Trainee Anaesthetists (2)
Trainee Perfusionists (4)
ODP’s (2)
Scrub Nurses (2)
Simulation allows the whole team to react as they would in an emergency
This study day enabled us, to discuss and deal with emergency situations which arise infrequently as a team.
Vital to have enough candidates to carryout their normal role in each scenario. Have backup faculty to step in if not
Training not Testing
Trainee Surgeons, Anaesthetists and Perfusionists took the lead roles in the scenarios
Having had the opportunity to practice should mean that the team should handle future problems in a more confident and cohesive manner.

12. Welcome and Introduction
Welcome and Introduction
09:
Lecture: Human Factors and Healthcare
Cardiopulmonary Bypass (CPB) Workshop
Lecture: Cannulation concerns/ TOE Simulator
12: :00
Lunch
Lecture: Failure to Oxygenate during CPB
13: :00
Simulation: Failure to Oxygenate during CPB
(Group 1 sim suite)
14:00 -14:30
Simulation Debrief (Group 1+2)
Coffee
14: :15
Lecture: Air Embolism during Cardiac Surgery
Simulation: Air Embolism
(Group 2 sim suite)
16:15 -16:45
Summary, Evaluation and Feedback
We began the day with a lecture about human factors and healthcare. This set the scene for the theme of the day. Discuss confidentiality; simulation, whilst it provides a setting where there is no harm to patients it is not stress free, dealing with emergencies in front of your peers.
Respect each member of the team and maintain confidentiality.
AM: Lectures and workshops .
In the afternoon we focussed on Critical incident simulations. We decided to deliver lectures first then undertake the simulation sessions. Delegates split into two groups. One involved in scenario, other group watched in lecture theatre. Debrief together.

13. Workshops
The multi-disciplinary team all had a go at performing the roles of a Perfusionist
Workshops in the morning allowed candidates to be ‘hands on’ with the simulator without participating in a scenario
An inter-professional study day provides an environment where all staff groups can contribute. There is a huge amount of knowledge and experience in the room
The workshops encouraged the teams to work together in the simulated environment which reduced the stress in the afternoon scenarios.
Give delegates a feel for the simulation suite/ manakin, bond with the team and insrtuctors
Identified things to look out for and discussed how to manage problems such as decannulation of the venous pipe or clamping the arterial line. Very important for surgeons to see how what happens at the table directly affects the CPB machine and perfusionist.

14. Critical Incident Simulation
Interprofessional simulation requires greater coordination and preparation than single profession.
- Develop scenarios that are relevant to all!
Critical Incident Management
This course provided a unique opportunity for all professions to develop a deeper understanding of the role each professional has and how they are interdependent in emergency situations.
The course would equip staff with the knowledge and experience to minimise future error and manage it effectively.
Identify key roles in emergency situations
- Massive air embolism
Failure to oxygenate during CPB
Two critical incidents were enough. It is important not to overload the candidates with information.
There is certainly a role for a study day that is solely focused on Perfusionists. St Georges run an excellent day for trainee surgeons where the day is structured for their training needs.

15. Critical Incident Simulation

16. Debriefing Combined both groups for debriefing
Debriefing was led by an external Clinical Perfusionist
Allow enough time to debrief
Having senior faculty available within the debriefing session was hugely valuable.
External staff led the debriefing session which worked well. Nobody felt they were being criticized – Personal relationships don’t get in the way of constructive debriefing.
Given enough time the debrief session is another learning opportunity; there is lots of knowledge in the room.

17. Feedback 0 = Not at all 5 = Very much indeed Question 4.96 4.83 4.61
Did you enjoy this simulation course?
4.96
How useful did you find the course?
4.83
How useful was ‘Human Factors in Healthcare’?
4.61
How useful was the cannulation workshop?
How useful were the simulation sessions?
4.87
How useful were the lectures?
4.82
I feel better able to manage critical incidents in the future.
4.65
For me, the most important points were –did you enjoy the course and the final point- I feel better able to manage critical incidents in the future
0 = Not at all
5 = Very much indeed

18. Feedback
“Has definitely increased my confidence in dealing with an air embolism”
“We should do these MD training days more often”
“ More simulation, less lectures”
Possibly in the future provide background pre course reading which would enabled more scenarios and less lectures.

19. What would we do differently next time?
Without a course fee it’s difficult to regulate attendance
Smaller groups
Limit the amount of places per speciality
Allow more time for the simulations
Almost half of the participants were surgical trainees!

20. There are lots of useful resources.
A multi-professional simulation day requires lots of preparation. You have nothing to lose!
There are lots of useful resources.
If you would like to see videos from this simulation day they are on YouTube (Circulate Medical).
Circulate Medical is a simulation company specific to cardiac surgery.
Journal articles specific to interprofessional simulation

21. Summary Our experience was positive We need to invest in safety
Lots of units are doing simulation - there’s the potential for Perfusionists to collaborate and develop excellent education
Is there a role for a Perfusion simulation group/ forum?
We all have storys of incidents or near misses- lets put them to use.

22. Thank You
Any Questions?