Transparent Reality Simulation of Perioperative Hemostasis: Preliminary Development and Implementation

Abstract

Introduction: Classical models of hemostasis have failed to adequately explain in vivo observations of coagulation and coagulopathy, especially in the perioperative setting in which multiple complicated processes affect the final hemostatic outcome. A new conceptual model of hemostasis, the cell-based coagulation model, has supplanted the classical model because it elucidates these in vivo observations. Anesthesiologists play a central role in correcting perioperative coagulopathies as well as preventing abnormal thrombosis. Although simulations exist, none exist that specifically illustrate the complex, dynamic perioperative setting and no simulation allows users to see how their interventions effect hemostasis. Objective: We propose the creation of a novel, interactive, internet-based simulation of perioperative coagulation to better educate all involved in the perioperative care of patients in current concepts of hemostasis, appropriate utilization and interpretation of coagulation tests and proper treatment of perioperative coagulopathy. Methods: In keeping with the goal of simulating hemostasis in the perioperative setting, we focus on clinical aspects based on basic science. To facilitate understanding, we apply transparent reality simulation techniques that allow users to interact with the model of hemostasis and visualize the essential effects of their interventions on hemostasis within a surgical setting. Results: As of this writing, the various concepts that have been explored for interactively simulating hemostasis can be viewed at http://vam.anest.ufl.edu/hemostasis. We will demonstrate our evolving work at the IMMS meeting in January 2006. Discussion: Despite anesthesiologists’ central role in perioperative hemostasis, we hypothesize anesthesiologists have a poor understanding of the current cell-based coagulation model, utility of coagulation tests and management of perioperative coagulopathy. This may lead to inaccurate interpretation of coagulation tests, over-utilization of certain treatments in lieu of more effective treatments and potentially suboptimal patient care. We hypothesize the use of an interactive, transparent, perioperative hemostasis simulator will increase anesthesiologists’ appropriate utilization and interpretation of coagulation tests, institution of correct interventions and ultimately improvement of perioperative outcomes. Once our transparent reality simulator is complete, we will conduct a multi-institution study to test our hypothesis using anesthesiologists at various levels of experience. Questionnaires administered pre-intervention, immediately post-intervention and several months post-intervention will assess the effectiveness and retention of our education tool.Table