Oak Hill Hospital
September 20, 2019

Dr. Wayne Simmons

Spring Hill, Florida - Oak Hill Hospital's Wayne Simmons, DO, first year anesthesiology resident, in conjunction with Jeffrey Huang, MD, FASA, Program Director of Oak Hill Hospital's Anesthesiology Residency, recently published a peer reviewed manuscript in Cureus Journal of Medical Science entitled "Operating Room Emergency Manuals Improve Patient Safety: A Systematic Review." The review is being translated into Chinese for publication on a prominent anesthesiology website.

The aim of this review was to highlight the latest movements surrounding Emergency Manual (EM) implementation nationally and abroad within perioperative medicine, with a focus on studies linking EMs to patient safety. It was a comprehensive literature review, which included not only an introduction to the definition and history of EMs, but also an overview of a successful implementation strategy, international influence, and correlations to patient safety. The recent changes in healthcare and healthcare reimbursement now directs focus throughout healthcare, to quality improvement and patient safety.

According to Dr. Simmons' review, prominent organizations have created EMs containing principles of evidence-based medicine and widely accepted protocols that have been endorsed by major entities in the medical field. Successful implementation strategies primarily focus on different forms of simulation training and have been found to increase adherence to protocols through EM use. An increasing amount of educational institutions and healthcare facilities worldwide, are perpetuating this implementation and a growing number of successful cases are being published.

What is an emergency manual?

An EM is a tool made to command all resources at hand in order to provide an anesthesia delivery plan, in concert with members of the anesthesia care team and operating room personnel in the aid of dynamic decision-making. According to Dr. Simmons "EMs are tools made to reliably optimize memory retrieval for rarely used information where the most frequent or hazardous omissions in patient care are found, as opposed to replacing the need for knowledge and continuous study."

Dr. Simmons says, "There is no need to reinvent the wheel. Many useful EMs have been created using a range of formats including interactive versions and recommended use with large screens and tablets." The specific operating room emergency manual used in Dr. Simmons' study—and implemented in the Oak Hill Hospital ORs—is published by Stanford Anesthesia Informatics & Media. It was prepared by the Stanford Anesthesia Cognitive Aid Group.

In December 2018, Oak Hill Hospital announced that Jeffrey Huang, MD, Program Director for HCA Anesthesiology Residency and Program Director for HCA Transitional Year Residency at Oak Hill Hospital, was invited to participate as a facilitator in the successful implementation of an EM simulation instructor-training course for anesthesia professionals in China. Dr. Huang serves on the Anesthesia Patient Safety Foundation (APSF) Committee on Education and Training and on the American Society of Anesthesiologists (ASA) Committee on International Collaboration.

The basis of the training course was that optimal outcomes in crises require that critical steps are performed in a timely manner. Increasing evidence suggests that checklists facilitate completion of critical steps in critical management. Studies suggest simulations significantly influence provider EM use. Simulation workshops, demonstrations, and training competitions had been tested and proven as effective ways to promote multi-disciplinary simulation training and implementation of operating room emergency manuals in China.

Dr. Simmons and Dr. Huang have already implemented simulation training at Oak Hill Hospital. When asked why he chose the research project, Dr. Simmons said, "I believe in seeking out best practices and implementing them regardless of colloquial norms. As humans, we are creatures of habit, but change is necessary for betterment. I hope that readers, through this study, can question the efficacy of rogue memorization in responding effectively to OR crises, recognize the potential of a successful Emergency Manual implementation both in training and continued education based on simulation, formulate a plan to integrate EM utilization, and resolve to generate case study research that demonstrates EM utilization with positive patient outcomes. Ideally this movement will increase patient safety at a local level for our hospital, as we become an example of positive change for others to follow."