Role Instructions
Physician (Conducting procedure)
1. Gown and glove physician.
2. Participate fully in the checklist-guided pre-procedure briefing and “time out”.
3. Simulate a right thoracentesis at conclusion of time out. Place 50 ml syringe up to mark on patient’s back, place bag of yellow pleural fluid on sterile field in full view of observers. Do not use needles on simulator.
4. Care for patient like you would normally.
Nurse
1. Initiate checklist-guided pre-procedure briefing. Use checklist as you see fit.
2. Go through items on checklist.
3. Conduct time-out like you would normally.
4. Care for patient like you would normally.
Certified Nurse’s Aid
1. Participate in checklist-guided pre-procedure briefing.
2. Help nurse and physician. If they ask you for supplies, exit room, obtain supplies.
3. During “time out” take a personal call on your cell phone (daughter, mother, friend, etc.). Do not hang up unless asked. Be loud enough to “interfere” with the time out.
Surgeon
1. Help if asked, called.
2. Ask for any relevant supplies or equipment as you enter room and engage in care of the patient.
3. Care for patient like you would normally.
4. If need to insert chest tube, place under skin flap on chest near one of electrodes gently.
Narrator/Stage Manager
- Provide patient background as follows (story version):
The patient is Richie Hernandez. He is a 62-year-old Viet Nam veteran who was awarded the Purple Heart. The survivors of his unit still consider him a hero. In terms of his medical history, that Purple Heart is evident on his abdomen where years ago he had an exploratory laparotomy and small bowel resection for a gunshot wound.
He came into the Emergency Room today with a fever that started a week ago. He is short of breath and complaining of chest pain. He has been taking Azithromycin for pneumonia without improvement. His chest x-ray showed a right pleural effusion, confirmed by CT scan.
His medical history includes COPD for which he uses an inhaler. He has an IV and is about to receive IV antibiotics – and he is getting oxygen by way of nasal prongs. He has been admitted here to the medical/surgical floor and is prepared and positioned for a thoracentesis. The team has completed most of the pre-procedure checklist and is nearly ready for the Time Out. Our patient is awake and if you ask, he will identify himself as Ritchie Hernandez born May 9th, 1949.
[May also want to add “We will be using name and birthdate as identifiers rather than social security number.]
More details if anyone asks (not crucial to scenario):
The CXR and CT scan were performed as part of his evaluation in the ER
The dose for Azithromycin was 250 mg daily (outpatient) for right pneumonia.
No known allergies to medicines.
History includes cigarette smoking and alcohol abuse (no cirrhosis or delirium tremens). His family history includes diabetes and multiple sclerosis.