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Friday, May 12, 2017

Mannequins and Actors Help Physicians Learn to Diagnose and Communicate Brain Death

Loyola Simulation Study Receives 2017 Safety and Quality Award

Brain illustration

MAYWOOD, IL –  One of the most difficult skills a neurologist must learn is how to diagnosis brain death and communicate the bad news to family members.

A Loyola Medicine study has found that two simulation techniques dramatically improved the brain death diagnostic and communications skills of neurologists in training. The techniques employ SimMan® 3G, a high-tech patient simulator (mannequin) that simulates a brain-dead patient and trained actors who simulate family members having a brain-death discussion with a physician.

The study was presented during the American Academy of Neurology’s annual meeting in Boston, where the study received the academy’s prestigious 2017 Safety and Quality Award.

Brain death is the irreversible loss of all functions of the brain. Clinically and legally, the patient is dead. (Brain death differs from persistent vegetative state, in which some autonomic functions such as breathing and sleeping persist.) The concept can be difficult to communicate to family members, who, for example, may wish to keep their loved-one on life support.

Brain death is determined with a procedure that includes a physical exam and an apnea test. In an apnea test, the patient is taken off the ventilator, and if there is no attempt to breathe, the patient is declared dead. Typically, a physician meets with the family to describe the procedure before it is performed. If the procedure confirms the patient is brain dead, the physician meets with the family again to deliver the bad news.

“The physician has only one chance to relay information in a compassionate way that the family can understand,” said Preston Douglas, MD, first author of the Loyola study. “The family’s whole view of the healthcare system can be enhanced or tainted depending on how well the discussion is conducted.”

The Loyola study included 12 neurologists who were beginning their second year of residency training. They were tested before and after they underwent brain death simulation training. Instructed by senior neurologists, the resident neurologists learned how to diagnose brain death using a patient simulator. The simulator can move and talk and realistically mimic human responses relevant to brain death testing, such as breathing and response to light. Instructed by palliative-care specialists, the resident neurologists learned how to discuss brain death with actors who played the roles of family members. (The actors are specialists from the Gift of Hope Organ & Tissue Donor Network.)

Before the training, the residents scored 46 percent on a test that measured how well they performed a brain death exam on the patient simulator, 48 percent on a test of how well they delivered bad news and 55 percent on an apnea test. After training, their scores improved to 73 percent, 74 percent and 91 percent, respectively.

Previous studies have shown how using patient simulators can help improve brain death diagnosis skills. The Loyola study is the first to show that using actors can help improve physicians’ communication skills in brain death discussions.

The study is titled, “Simulation-based training in brain death determination incorporating family discussion: An update to an ongoing project.”

The study is part of a collaborative Care Team project that has been ongoing for several years and involves many participants. In addition to Dr. Douglas, other Loyola co-authors of the brain death study are Carolyn Goldschmidt, DO, Jorge Ortiz, MD, Michael Doerrler, DO, Lauren Ottenhoff, DO, Mark Speyer, MD, Aziz Ansari, DO, Michael Schneck, MD, and Matthew McCoyd, MD.

The study won the American Academy of Neurology’s Safety and Quality Award in the residents-and-fellows category. The award recognizes research and/or quality improvement projects designed to improve safety and/or quality in clinical practice.

In 2015, Loyola neurologists won a Safety and Quality award for a study that found that a patient simulator and other simulation-based techniques significantly improved the knowledge, skills and confidence of first-year neurology residents treating stroke patients in the emergency department. 

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 92 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 129,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.