Game, to standardize the VA team approach to non-OR airways. Abstract ... Environments at the International Meeting on Simulation in Healthcare. ... serious gaming in place of traditional live simulation for complex and dynamic clinical.
Difficult Airway Algorithm and Rescue Cricothyrotomy (DAARC) Serious Game, to standardize the VA team approach to non-OR airways Jessica L Feinleib MD PHD1, Lynette Mark MD2, Arthur French MD3, Paul Flint MD4, Laeben Lester MD2 1VACTHS, West
Haven CT & Yale University School of Medicine, New Haven CT, 2Johns Hopkins Hospital, Baltimore, MD, 3 VA Puget Sound HCS, Seattle WA and 4OHSU, Portland OR
Abstract Summary Introduction: In an effort to reduce VHA patient morbidity and mortality associated with failed airways, VHA SimLEARN undertook the production of an educational program addressing the Difficult Airway Algorithm and Rescue Cricothyrotomy (DAARC) (1). The goal of this educational system is to provide mastery based medical education delivered remotely to the ~150 hospitals in the VHA system. Many have proposed the importance of mandatory post certification airway education (2). We opted for a novel composite educational tool and blended learning curriculum, incorporating serious gaming, called the DAARC educational program Figure 1. This program is centered on the Vortex system cognitive aid that is in alignment with the most recent with DAS and ASA airway guidelines (3) Figure 2. The DAARC educational system consist of video didactics, podcasts, a formative serious game and a summative round of the DAARC serious game Figure 3-5. The target audience for this multimillion-dollar project includes all airway team members e.g. anesthesiologists, surgeons, emergency and critical care physicians as well as respiratory therapists and critical care nurses. Methods: In January 2017 the DAARC game won "Best in Show" for Games and Virtual Environments at the International Meeting on Simulation in Healthcare. The VHA is now engaging in a collaborative validation process with academic medical centers for the DAARC program. A pilot study on difficult airway management is underway at multiple sites comparing the DAARC serious game curriculum to similar content from traditional educational materials, textbook, etc. This will then be followed by traditional simulation, in a flipped classroom format. We will randomly assign subjects to these different educational groups and then follow their clinical behavior during simulation airway management. Simulation outcomes that will be recorded are the use of the cognitive aid(Vortex), time to obtain a successful airway, number of attempts in each technique, number of attempts with an optimization of each technique, time interval from failure of non-surgical interventions until cricothyrotomy i.e. time from recognition of need surgical rescue to front of neck access. Conclusions: After 3 years of design, programing, production, and editing the DAARC program is currently live in the VHA learning management system and awaiting validation of it’s training effectiveness. As DAARC is an innovative training program that relies on serious gaming in place of traditional live simulation for complex and dynamic clinical decision making (4). We wish to determine if this educational modality is effective and based on that information make recommendations to the national VHA service chiefs on the potential use of the DAARC program. Additionally, the 2012 VA Out-ofOperating Room Airway Management (OORAM) directive is scheduled for a revision and we are aiming to provide data that will give guidance on the use of DAARC in the VHA credentialing system. If proven effective the use of the DAARC program could provide the 150 VHA hospital system with a mastery based airway educational system for the maintenance of credentialing. Additionally, DAARC would then standardize and align all VHA airway management practice with current ASA and DAS guidelines and thereby, improve veteran airway safety. References: 1) NAP-4 http://www.rcoa.ac.uk/system/files/CSQ-NAP4-ES.pdf 2) Is it time for airway management education to be mandatory? BJA, June, 1-4, 2016 3) The Vortex: striving for simplicity, context independence and teamwork in an airway cognitive tool. BJA, Jul;115(1):148-9, 2015 4) Effect of simulation training on compliance with difficult airway management algorithms, technical ability, and skills retention for emergency cricothyrotomy. Anesthesiology, 120:999-1008, 2014
Difficult Airway Algorithm and Rescue Cricothyrotomy (DAARC) Game
Composite program video didactics, formative and summative serious games, and a hands on simulation. Uniform Difficult Airway Algorithm and standardized Cognitive aid to create common language and remove communication barriers.
Leaning Objectives Intentional Airway Education
Airway Education Model
• • • • • •
Scoring and Game Play
Obtaining patients airway Use of airway tools with optimizations Communicating with the Team ”The learner will be able to”…. Use of the Vortex cognitive aid Use of ETCO2 classify the risk factors for an anticipated failed airway Penalty for use of cricothyrotomy when not recognize an unanticipated failed airway in a clinically relevant necessary timeframe • Once the formative game is passed then the learner employee a Front of neck access for failed airways is given 4 summative games apply the Vortex cognitive aid enhancing a shared mental model of airway management The Vortex Cognitive Aid apply and manage Wave Form ETCO2 for Out of Operating Room Airway Management • • • • • •
International Meeting Simulation in Healthcare (IMSH) 2017 Winner of the large company division
ABA and DAARC MOCA • Application to the ABA for MOCA part 2 Patient Safety CME has been submitted.
