Pediatric Radiology

, 38:700 | Cite as

Medical simulation: a tool for recognition of and response to risk

  • Richard M. RuddyEmail author
  • Mary Deffner Patterson


The use of simulation and team training has become an excellent tool to reduce errors in high-risk industry such as the commercial airlines and in the nuclear energy field. The health care industry has begun to use similar tools to improve the outcome of high-risk areas where events are relatively rare but where practice with a tactical team can significantly reduce the chance of bad outcome. There are two parts to this review: first, we review the rationale of why simulation is a key element in improving our error rate, and second, we describe specific tools that have great use at the clinical bedside for improving the care of patients. These cross different (i.e. medical and surgical) specialties and practices within specialties in the health care setting. Tools described will include the pinch, brief/debriefing, read-backs, call-outs, dynamic skepticism, assertive statements, two-challenge rules, checklists and step back (hold points). Examples will assist the clinician in practical daily use to improve their bedside care of children.


Simulation Team training Human factors Latent safety errors Situational awareness 


  1. 1.
    Kohm LT, Corrigan JM, Donaldson MS (eds) (2000) To err is human: building a safer health care system. Institute of Medicine. National Academies Press, Washington, DCGoogle Scholar
  2. 2.
    Gaba D (2004) The future vision of simulation in health care. Qual Safe Heal Care 13(supp):i1–i10CrossRefGoogle Scholar
  3. 3.
    Leach D (2005) Simulation and rehearsal: practice makes perfect. ACGME Bulletin, DecemberGoogle Scholar
  4. 4.
    Gawande A (2002) Complications: a surgeon’s notes on an imperfect science. Picador, New York, p 20Google Scholar
  5. 5.
    Croskerry P, Wears RL, Binder LS (2000) Setting the educational agenda and curriculum for error prevention in emergency medicine. Acad Emerg Med 7:1194–2000PubMedCrossRefGoogle Scholar
  6. 6.
    Leonard M, Frankel A, Simmonds T et al (2004) Achieving safe and reliable healthcare. Health Administration PressGoogle Scholar
  7. 7.
    Leonard M, Graham S, Bonacum D (2004) The human factor: the critical importance of effective teamwork and communication in providing safe care. Qual Safe Heal Care 13(supp):i85–90CrossRefGoogle Scholar
  8. 8.
    Paris CR, Salas E, Cannon-Bowers JA (2000) Teamwork in multi-person systems: a review and analysis. Ergonomics 43:1052–1075PubMedCrossRefGoogle Scholar
  9. 9.
    Helmreich RL (2000) On error management: lessons from aviation. BMJ 220:781–785CrossRefGoogle Scholar
  10. 10.
    Koppel R, Metlay JP, Cohen A et al (2005) Role of computerized physician order entry systems in facilitating medication errors. JAMA 293:1197–1203PubMedCrossRefGoogle Scholar
  11. 11.
    Kobayashi L, Shapiro MJ, Sucov A et al (2006) Portable advanced medical simulation for new emergency department testing and orientation. Acad Emer Med 13:691–695CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Division of Emergency Medicine ML 2081Cincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiUSA
  3. 3.Simulation Center, Cincinnati Children’s Hospital Medical Center, Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiUSA

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