Can bronchoscopy be made safer through team-based Simulation?

Abstract

Introduction: Fibreoptic bronchoscopy is performed in a variety of patients. Potential complications include respiratory failure and bleeding. We looked at whether team-based simulation could improve the management of these complications. Methods: Five sessions were run every 6 months in the endoscopy unit using a mannequin with a bronchial tree. The scenario started from the WHO checklist to completion of the case. Consultants underwent the scenario initially, then ran the simulation at each change of junior doctors with endoscopy staff. During the simulation, the patient developed respiratory failure. It examined skills such as identification of the deteriorating patient, decision to stop the procedure, resuscitation including use of oxygen and bag valve mask and reversal agents. After each simulation, debriefing was performed and written feedback gained. Results: 8 consultants, 9 trainees and 8 nurses took part. 82% said they have changed practice as a result. Several noted the importance of a specific patient focussed initial team brief, including discussion of when the procedure should be aborted. Some nurses had noticed the deteriorating patient but commented on the observations without actually saying “stop”. Discussion: Simulation allows staff to practise how to manage emergencies in a safe environment. The sessions highlighted the importance of a patient specific team brief and it reinforced that all staff should be able to suggest stopping the procedure. A simulation scenario is now run in the first bronchoscopy session when trainees start at our hospital. Bronchoscopy simulation is useful not only in teaching learners how to do the procedure, but can also teach teams how to cope when emergencies occur.