Marc Auerbach, MD, FAAP, MSc

My area of research scholarship involves using technology and innovative techniques to improve the quality and safety of care through work at the level of individual providers, teams of providers, and teams of providers working within complex systems. I currently serve as the co-director of INSPIRE (International Network for Simulation-based Pediatric Innovation Research and Education), the largest simulation-based research network in the world. Two major themes in my work are 1) the creation of effective simulation-based training interventions and 2) the use of simulation as an investigative methodology.

I have created, measured and iteratively adapted simulation-based training interventions to improve provider performance and patient outcomes. A series of my studies were framed around infant lumbar puncture procedural skills training. These interventions involved the application of established instructional design techniques as well as the development of innovative techniques that utilize simulation-based technologies. For example, my work has changed the culture surrounding this procedure by implementing a work-place based simulation initiative where interns are refreshing their skills and being tested immediately prior to performing on a real infant patient. This series of clinical translational research projects is involved: examining the impact of our interventions on provider’s knowledge, skills and attitudes (T1- simulation lab), examining how these providers simulation-based performance impacted their clinical performance and procedural success on real patients (T2 clinical environment), and most recently completing a 30 center multi-site study examining the impact of this work on population level patient outcomes (T3 health care systems). While this LP project focused on developing and retaining individual provider’s psychomotor procedural skills I have other projects exploring training for more complex processes of care (cardiopulmonary resuscitation), and for teams of providers caring for patients (trauma resuscitation, Team STEPPS).

My work utilizing simulation as the environment of research utilizes simulation to control for patient factors in order to examine provider and system factors. I have completed a number of studies examining the use of simulation to improve the quality and safety of pediatric trauma care. This past year I completed the first phase of a large collaborative project ImPACTS: Improving Pediatric Acute Care Through Simulation. ImPACTS aims to improve the quality of pediatric acute care whenever and wherever it is needed. In year one we described, measured and compared the quality of pediatric acute care in a spectrum of thirty emergency departments. We have a series of six manuscripts based on this work that have been submitted for publication. Most recently we have partnered with leaders at HRSA and EMSC on the next phase of creating interventions based on this initial needs assessment.

This work provided the experience and foundation for an AHRQ grant that was recently awarded to our team looking at transitions in care from community EDs to tertiary care hospitals. This grant will be supporting CHIRAL, the Center for Healthcare Innovation, Redesign, and Learning. Patients being transferred from one setting to another or one clinical team to another are at increased risk for a host of failures including identification errors, delayed or missed diagnoses, redundant testing, treatment delays or errors, medication errors, and unexpected clinical deterioration. Ensuring the safety of patients during transitions of care has long been one of the biggest challenges facing the healthcare system. This is Yale’s first center devoted to patient safety, quality improvement and is a joint venture of YNHH and YSM. It is trans-disciplinary and will involve students and faculty from a variety of existing schools (Management, Nursing, Public Health, Art, Medicine, Engineering, Computer Science, Biomedical Engineering) in a dynamic research environment to improve patient safety and redesign this process. The initial year of this grant will involve a needs analysis and an iterative redesign to this process in the simulation lab. In future years this grant we will translate our findings to real patient care (T2) and population level outcomes (T3).

In the future I hope to continue to work with others at Yale and across the globe to understand how to safely, effectively and efficiently train and maintain providers skills as well as leverage simulation to understand how to improve quality and safety in complex systems of care.