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Intérêt de la simulation haute-fidélité dans l’évaluation de l’application de procédures de soins par les médecins urgentistes

High-fidelity simulation to assess care protocols implemented by emergency physicians

  • Article Original / Original Article
  • Published:
Annales françaises de médecine d'urgence

Résumé

Objectif

La simulation haute-fidélité est de plus en plus utilisée comme outil de formation. L’objectif de notre étude était d’évaluer l’intérêt de la simulation haute-fidélité comme aide aux médecins urgentistes pour mieux appliquer les procédures de soins.

Matériel et méthodes

Étude prospective évaluant la performance des médecins dans l’application correcte de procédures de soins standardisées sur la prise en charge d’une intubation difficile, d’un traumatisme crânien grave (TCG) et d’un arrêt cardiaque lors de deux séances de simulation (S1 et S2) à six mois d’intervalle par un évaluateur unique.

Résultats

Dix-sept médecins ont été évalués (durée moyenne d’expérience professionnelle de 9 ± 4 ans). La procédure d’intubation difficile était correctement appliquée par six (35 %) médecins lors de S1 et 13 (76 %) médecins lors de S2 (p = 0,02). La différence principale dans l’application de la procédure TCG résidait essentiellement au niveau de la prévention des agressions cérébrales secondaires d’origine systémique. Le nombre de médecins appliquant correctement la procédure TCG a augmenté de cinq (29 %) lors de S1 à 12 (71 %) lors de S2 (p = 0,03). Le nombre de médecins assurant une réanimation cardiopulmonaire d’un arrêt cardiaque selon les recommandations a augmenté de sept (41 %) lors de S1 à 14 (82 %) lors de S2 (p = 0,02).

Conclusion

Après deux séances de simulation à six mois d’intervalle, les performances des médecins urgentistes et leur application des procédures de soins se sont significativement améliorées. Cette étude a montré que les simulateurs hautefidélité peuvent être utilisés efficacement dans le cadre de la formation continue des médecins urgentistes confirmés.

Abstract

Aim

High-fidelity simulation is increasingly used as a teaching tool. The aim of this study was to assess the impact of high-fidelity simulation in helping emergency physicians to better implement standard care protocols.

Procedure

It is a prospective study assessing the performance of physicians in applying the correct procedures for the management of difficult intubation, severe traumatic brain injury (TBI) and cardiac arrest during 2 simulation sessions (S1 and S2), separated by a 6-month interval, by a single assessor using evaluation grids derived from standard care protocols.

Results

Seventeen senior emergency physicians with a mean experience of 9 ± 4 years participated in the study. The protocol for difficult intubation was correctly implemented by 6 physicians (35%) in S1 and 13 physicians (76%) in S2 (P = 0.02). The major difficulty in implementing the severe TBI management protocol was the prevention of secondary systemic insults to the brain. The number of physicians correctly implementing the TBI protocol increased from 5 (29%) in S1 to 12 (71%) in S2 (P = 0.03). The number of physicians performing cardiopulmonary resuscitation after cardiac arrest as per guidelines increased from 7 (41%) in S1 to 14 (82%) in S2 (P = 0.02).

Conclusion

After two simulator-based sessions with an interval of 6 months, the physicians performance and compliance with standard care protocols improved significantly, thus demonstrating that high-fidelity simulators can be used effectively in continuing medical education and professional development of experienced emergency physicians.

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Authors and Affiliations

  1. Département d’anesthésie-réanimation et Samu-Smur, 75, hôpital Necker-Enfants-malades (Assistance Publique - Hôpitaux de Paris), 149, rue de Sèvres, F-75015, Paris, France

    P. Jabre, X. Combes & H. Coignard

  2. Inserm U970, centre de recherche cardiovasculaire de Paris, université Paris-Descartes, 56, rue Leblanc, F-75015, Paris, France

    P. Jabre

  3. Département d’anesthésie-réanimation chirurgicale et Samu-Smur, 94, hôpital Henri-Mondor (AP-HP), université Paris-XII, 51, avenue du Maréchal-de-Lattre-de-Tassigny, F-94010, Créteil, France

    C. Jbeili, A. Margenet, E. Lecarpentier, J. Marty & C. Bertrand

  4. Institut Mondor pour la recherche biomédicale, Inserm U955, université Paris-XII, Val-de-Marne, F-94000, Créteil, France

    J. -P. Farcet

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  1. P. Jabre
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  2. C. Jbeili
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Correspondence to P. Jabre.

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Jabre, P., Jbeili, C., Combes, X. et al. Intérêt de la simulation haute-fidélité dans l’évaluation de l’application de procédures de soins par les médecins urgentistes. Ann. Fr. Med. Urgence 1, 379–386 (2011). https://doi.org/10.1007/s13341-011-0122-4

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  • DOI: https://doi.org/10.1007/s13341-011-0122-4

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