Rama Asheen, Knight Lynda J, Berg Marc, Chen Michael, Gonzales Ralph, Delhagen Timothy, Copperman Lucas, Caruso Thomas J
Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA.
Lucile Packard Children's Hospital Stanford, Palo Alto, CA.
Pediatr Qual Saf. 2019 Sep 27;4(6):e222. doi: 10.1097/pq9.0000000000000222. eCollection 2019 Nov-Dec.
Pediatric patients in intraoperative magnetic resonance imaging (iMRI) settings are at high risk for morbidity should an adverse event occur. We describe an experience in the iMRI scanner where no harm occurred, yet revealed an opportunity to improve the safety of patients utilizing the iMRI. The perioperative quality improvement team, resuscitation team, and radiology nurse leadership collaborated to understand the process better through in situ simulation.
After a problem analysis, the team planned an in situ, high-fidelity simulation with predefined learning objectives to identify previously overlooked opportunities for improvement. The iMRI simulation had unique considerations, including the use of a magnetic resonance imaging (MRI)-compatible mannequin and ensuring participants' safety. Audiovisual equipment was placed in strategic locations to record the MRI and operating room (OR) segments of the simulation, and trained health-care simulation experts provided debriefing.
After completion of the iMRI simulation, the quality improvement team solicited feedback from participants and reviewed the video-recorded simulation. Several opportunities for improvement surrounding staff responsibilities and unique aspects of the iMRI environment were identified.
iMRI in situ simulation has not been previously described. It presents unique challenges given the integration of personnel from OR and radiology environments, anesthetized patients, and risks from the high-powered MRI magnet. Other institutions utilizing hybrid ORs with iMRI may consider conducting in situ simulations using the described methods.
在术中磁共振成像（iMRI）环境下的儿科患者若发生不良事件，发病风险很高。我们描述了一次在iMRI扫描仪中的经历，虽然未造成伤害，但揭示了一个改善使用iMRI患者安全性的机会。围手术期质量改进团队、复苏团队和放射科护士领导层合作，通过现场模拟更好地了解该过程。
经过问题分析后，团队计划了一次具有预定义学习目标的现场高保真模拟，以识别之前被忽视的改进机会。iMRI模拟有独特的考虑因素，包括使用与磁共振成像（MRI）兼容的人体模型以及确保参与者的安全。视听设备放置在关键位置，以记录模拟的MRI和手术室（OR）部分，训练有素的医疗模拟专家进行总结汇报。
iMRI模拟完成后，质量改进团队征求了参与者的反馈意见，并查看了视频记录的模拟过程。确定了围绕工作人员职责和iMRI环境独特方面的几个改进机会。
之前尚未描述过iMRI现场模拟。鉴于手术室和放射科环境的人员整合、麻醉患者以及高功率MRI磁体带来的风险，它带来了独特的挑战。其他使用带有iMRI的混合手术室的机构可能会考虑使用所述方法进行现场模拟。
