Nurse Anesthetists: Improving the landscape of healthcare safety

The cost of healthcare delivery, as described in To Err is Human, can be high.  More people die from healthcare misadventures each year than from highway accidents, breast cancer, or AIDS.  This report clearly affirms that the problem is not bad people delivering healthcare; rather it is that excellent people are working in highly complex, inherently dangerous, and often poorly designed systems that need to be made safer.

The American Association of Nurse Anesthetists (AANA) in collaboration with faculty at Virginia Commonwealth University (VCU) under the direction of Professor Michael Fallacaro, Chairman of the Department of Nurse Anesthesia, are developing patient safety vignettes (PSVs) that reenact common areas of healthcare delivery that are grounded in national standards of practice.  The AANA and VCU faculty have a long record of promoting research, education and practice directed at improving the safety of patients.

Patient safety vignettes (PSVs) are brief, filmed reenactments of actual clinical situations that stimulate healthcare providers to analyze situations in a safe environment where no real patients are involved.  Following each film a best-evidence approach is provided to the clinician so that a strategy can be developed to prevent or treat the problems portrayed in the film.  PSVs may be particularly effective in analyzing complex situations that occur in healthcare that would otherwise be difficult or dangerous to reproduce using real patients.

Imagine training a soldier, policeman, airline pilot, nuclear power station operator, or air traffic controller to deal with the complex, stressful, and dangerous situations that they are likely to encounter in the “real world.” When seated in a passenger plane as we head off on vacation or business, we trust that the pilot(s) have been trained in dealing with all sorts of common and uncommon problems.  Using PSVs, nurse anesthesia clinicians and students are afforded the opportunity to learn from the experiences of others in a safe, controlled manner, as the events unfold in a highly realistic manner.

Here at VCU we measure the impact of these simulation programs and have powerful data indicating that PSVs are associated with greater “imprint” on the memories and performance of healthcare providers than traditional forms of information dissemination.  We believe that this is due to 3 factors: 1) the strength of vicarious learning---that is, the feeling that “this could happen to me!”, 2) the power of “storytelling” to impart a message,  and 3) human  information processing---“a picture is worth a thousand words”.

Building a Culture of Safety

This is just one example of the kind of patient safety research and education that CRNAs nationally are engaged in.  At the core of these ventures is the building and nurturing of a culture of safety. This kind of cultural change does not happen overnight. The healthcare organizations in which CRNAs are crucial providers are actively creating environments where patient safety is a top priority.

CRNAs are highly educated, safety-conscious, and caring individuals.  Academic and professional criteria for entry into the field are high, as are the challenges faced each and every day in delivering quality care to those undergoing surgery and other painful and stressful procedures.  Research and experience conclusively reveal that CRNAs deliver clinical care of the very highest caliber.  CRNAs are at the cutting edge of research and development that will serve to maximize patient safety and efficacy in the new millennium.

Chuck Biddle  CRNA, PhD
Professor, Virginia Commonwealth University