Better training, Better healthcare…

Dr. Thomas Burch M.D., Cardiac Anesthesiologist from Boston Children’s Hospital gives a personal account of how simulation training using the HeartWorks system helped to increase his confidence with transthoracic echocardiography (TTE) in his patient care.

“I first came across the HeartWorks Simulator back in 2005 when I began teaching Transesophageal Echocardiography (TEE). At that time it was extremely difficult (essentially impossible) to teach hands-on TEE outside the hospital. We tried to accomplish this via lectures and use of models but they were only semi-successful. When we began using the HeartWorks TEE simulator, the entire teaching and learning experience changed dramatically for the better.

Building confidence in TEE and TTE

HeartWorks ultrasound simulation technology is a catalyst for learning and has been comprehensively utilized at the Society of Pediatric Anesthesia and the Harvard Pediatrics review course to teach both TEE and TTE to many hundreds of physicians. It is a great example of how technology can make an impact on improving medical care, and a patient case of mine only recently makes the case in point.

Ultrasound has become a ubiquitous clinical component of patient care and the transthoracic probe has replaced (or at least augmented) the use of a stethoscope for troubleshooting the complex cardiac patient undergoing perioperative care. As both an adult and pediatric cardiac anesthesiologist, I have benefited from the use of both TEE and TTE to assist in patient care preventing unnecessary delays to treatment when a patient presents with an incomplete workup, or a new physical finding such as a previously unappreciated murmur is discovered.

How simulation has helped to improve patient outcomes

Last week I cared for an 86-year-old man with poor functional capacitance who came to the hospital for an elective screening colonoscopy. He had a systolic aortic murmur and NONE of his prior records were available. Here was the dilemma. Did he have critical aortic stenosis? Was it safe to perform elective anesthesia? Did I need to get a cardiology consult? Waiting for a cardiology evaluation might mean cancellation of this procedure. His son had taken time off work to arrange for his transport to the hospital and the patient himself had been fasting for over 12 hours and had to drink the wonderfully misnamed concoction “go-lightly” to clean out his system. Needless to say, he was not excited about the possibility of postponement. So, I pulled out a small TTE machine, obtained a quick view of his slightly sclerosed aortic valve and we were able to proceed without unnecessary delays or costly additional consults. Without my training on the HeartWorks system, I personally would not have had the confidence to accomplish this. Although I am very confident at performing transesophageal echocardiography, my ability to perform TTE just a few years ago was minuscule.

Now, I assist in teaching others this valuable skill and at the same time have developed friendships and contacts that have truly made a difference in my career as a perioperative physician.”

Further information: Boston Children’s Hospital thomas.burch@childrens.harvard.edu