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Loma Linda medical simulation center aims to reduce errors

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Loma Linda medical simulation center aims to reduce errors

The Loma Linda University risk management department has committed part of its budget to fund the university health system's medical simulation center to back its belief that the training it provides to a wide range of clinical professionals reduces medical errors.

Loma Linda established its SIM center in 2005 to train medical students using technology that reproduces realistic human physiology in real time.

Since 2007, Loma Linda's risk management department has contributed more than $900,000 in surpluses from its budget to support the SIM center, said Mark L. Hubbard, senior vp of risk management for the Loma Linda, Calif.-based health system.

Loma Linda's primary source of gains in its self-insurance program has been effective claims management and loss prevention, Mr. Hubbard said.

The SIM center is partially funded by its captive, University Insurance Co. of Vermont, and the self-insurance trust, which Loma Linda views as one budget.

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The captive writes the first layer of excess liability insurance, which includes professional and general liability, with a self-insurance trust that assumes the primary layer of coverage.

The risk management department has funded a number of simulators and helped develop specific training scenarios addressing high-risk areas such as obstetrics and emergency room procedures, Mr. Hubbard said, noting that this year's efforts include four new simulators.

“In comparison to the budgets that we have for professional liability—and any institution of our size is required to put up pretty substantial funding to support medical malpractice funding—the SIM center's budget is relatively modest compared to what we spend on medical malpractice,” Mr. Hubbard said.

Since the SIM center's inception, the program today offers training on 16 human simulators in an 8,000-square-foot facility that can be transformed into various emergency and clinical settings, said Dr. Kent Denmark, the director of Loma Linda's SIM center.

“The thought process behind that was to be able to take one simulator and move it all the way through the continuum of care so that we can work not just on the clinical procedures, which there are quite a few we could do, but also look at the teamwork, communication and the handoffs between the different disciplines, which is where a lot of the medical errors occur,” Dr. Denmark said.

“Based on our loss experience, we certainly have identified common areas for potential errors or scenarios that we know represent significant risk to the patient,” Mr. Hubbard said.

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An early simulation effort focused on cesarean sections.

“We discovered some things in our system that were not very smooth, to say the least,” Dr. Denmark said. “We were able to proactively correct things” before they became an issue in patient care.

While quantifying results from the program is difficult, Dr. Denmark said there have been significant advances in communication among clinicians. “Fortunately, we work in an environment where claims are so low to begin with it would take years of data to show the claims have dropped lower,” he said.

“We do know anecdotally that if we were successful in eliminating one patient injury, it could potentially pay for the simulation training program for the year,” Mr. Hubbard said.

“We know that the potential injury to the patient and the loss associated with that is so significant in some of these high-risk areas that, even if we can't immediately measure the results, we still believe it's the right thing to do because we know that we have better-prepared clinicians, and we believe that ultimately it is going to reduce the risk of patient injury,” Mr. Hubbard said.

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