Steven K. Howard

Administrative Appointments

• Member, Committee on Occupational Health, American Society of Anesthesiologists , (2002– present )
• Member, Resident Selection Committee, Department of Anesthesia , (1997– present )
• Member, Resident Education Committee, Department of Anesthesia , (1993– present )
• Member, Clinical Competence Committee, Department of Anesthesia , (2001– present )

Professional Education

• --, Stanford Anesthesia (1991)
• --, Cedars-Sinai, UCLA Internship (1988)
• MD, Chicago Medical School Medicine (1987)
• BA, UC Santa Barbara Pharmacology (1983)

Web Site Links

• Simulation Center @ VA Palo Alto HCS

Research Interests

Our laboratory (please also refer to David M. Gaba M.D.) is active in the study of human performance of medical personnel. We are actively involved in teaching health care personnel the technique of crisis resource management (CRM) using realistic simulation.

My research centers on the effects of sleepiness and fatigue in medical personnel. Data from our studies reveal resident physicians to be pathologically sleepy (as tested in the sleep laboratory) during normal working conditions as well as in the post on-call condition. If the same subjects are allowed to extend night time sleep by two hours for four consecutive days they return to normal states of alertness. We have evaluated the effects of sleep deprivation on clinical performance using a realistic simulator. We are currently measuring the sleep propensity and performance of health care personnel (nurses, residents and staff physicians). Our laboratory has been funded for five years by the VHA Patient Safety Center of Inquiry Program.

Publications

• Improvement in coronary anastomosis with cardiac surgery simulation. Fann JI,  Caffarelli AD, Georgette G, Howard SK, Gaba DM, Youngblood P, Mitchell RS, Burdon TA.  J Thorac Cardiovasc Surg.  2008; 136 (6): 1486-91
• Using the rapid response system to provide better oversight of patient care processes. Moore MS,  Howard SK, Lighthall G.  Jt Comm J Qual Patient Saf.  2007; 33 (11): 695-8, 645
• Use of cognitive aids in a simulated anesthetic crisis. Harrison TK,  Manser T, Howard SK, Gaba DM.  Anesth Analg.  2006; 103 (3): 551-6
• Clinicians' recognition of the Ohmeda Modulus II plus and Ohmeda Excel 210 SE anesthesia machine system mode and function. Sowb YA,  Howard SK, Raemer DB, Feinstein D, Fish KJ, Gaba DM.  Simul Healthc.  2006; 1 (1): 26-31
• Clinicians' recognition of the Ohmeda Modulus II Plus and Ohmeda Excel 210 SE anesthesia machine system mode and function Sowb, YA,  Howard SK, Raemer DB, Feinstein D, Fish KJ, Gaba DM.  Simulation in Healthcare.  2006; 1 (1): 26-31
• So many roads: Faciltiated debriefing in healthcare Dismukes, RK,  Gaba DM, Howard SK.  Simulation in Healthcare.  2006; 1 (1): 23-25
• Use of a nap to improve alertness and performance in physicians and nurses in the emergency department Smith-Coggins R,  Howard SK, Mac DT, Wang C, Kwan S, Rosekind MR, Sowb YA, Balise, R, Levis D, Gaba DM.  Ann Emerg Med.  2006; (in press)
• Improving alertness and performance in emergency department physicians and nurses: the use of planned naps. Smith-Coggins R,  Howard SK, Mac DT, Wang C, Kwan S, Rosekind MR, Sowb Y, Balise R, Levis J, Gaba DM.  Ann Emerg Med.  2006; 48 (5): 596-604, 604.e1-3
• Sleep deprivation and physician performance: why should I care? Howard SK,  Proc (Bayl Univ Med Cent).  2005; 18 (2): 108-12; discussion 112-3
• Trainee fatigue: are new limits on work hours enough? Howard SK,  Gaba DM.  CMAJ.  2004; 170 (6): 975-6
• Emergency medicine crisis resource management (EMCRM): pilot study of a simulation-based crisis management course for emergency medicine. Reznek M,  Smith-Coggins R, Howard S, Kiran K, Harter P, Sowb Y, Gaba D, Krummel T.  Acad Emerg Med.  2003; 10 (4): 386-9
• The culture of safety: results of an organization-wide survey in 15 California hospitals. Singer SJ,  Gaba DM, Geppert JJ, Sinaiko AD, Howard SK, Park KC.  Qual Saf Health Care.  2003; 12 (2): 112-8
• Simulation study of rested versus sleep-deprived anesthesiologists. Howard SK,  Gaba DM, Smith BE, Weinger MB, Herndon C, Keshavacharya S, Rosekind MR.  Anesthesiology.  2003; 98 (6): 1345-55; discussion 5A
• Use of a fully simulated intensive care unit environment for critical event management training for internal medicine residents. Lighthall GK,  Barr J, Howard SK, Gellar E, Sowb Y, Bertacini E, Gaba D.  Crit Care Med.  2003; 31 (10): 2437-43
• Fatigue in anesthesia: implications and strategies for patient and provider safety. Howard SK,  Rosekind MR, Katz JD, Berry AJ.  Anesthesiology.  2002; 97 (5): 1281-94
• Patient safety: fatigue among clinicians and the safety of patients. Gaba DM,  Howard SK.  N Engl J Med.  2002; 347 (16): 1249-55
• The risks and implications of excessive daytime sleepiness in resident physicians. Howard SK,  Gaba DM, Rosekind MR, Zarcone VP.  Acad Med.  2002; 77 (10): 1019-25
• Time for a new paradigm in pediatric medical education: teaching neonatal resuscitation in a simulated delivery room environment. Halamek LP,  Kaegi DM, Gaba DM, Sowb YA, Smith BC, Smith BE, Howard SK.  Pediatrics.  2000; 106 (4): E45
• Attitudes toward production pressure and patient safety: a survey of anesthesia residents. Healzer JM,  Howard SK, Gaba DM.  J Clin Monit Comput.  1998; 14 (2): 145-6
• Assessment of clinical performance during simulated crises using both technical and behavioral ratings. Gaba DM,  Howard SK, Flanagan B, Smith BE, Fish KJ, Botney R.  Anesthesiology.  1998; 89 (1): 8-18
• Factors influencing vigilance and performance of anesthetists. Howard SK,  Gaba DM.  Curr Opin Anaesthesiol.  1998; 11 (6): 651-7
• Simulated anaesthetic emergencies. Gaba DM,  Howard SK.  Br J Anaesth.  1997; 79 (5): 689-90; author reply 690-1
• Situation awareness in anesthesiology. Gaba DM,  Howard SK, Small SD.  Hum Factors.  1995; 37 (1): 20-31
• Production pressure in the work environment. California anesthesiologists' attitudes and experiences. Gaba DM,  Howard SK, Jump B.  Anesthesiology.  1994; 81 (2): 488-500
• Anesthesia crisis resource management training: teaching anesthesiologists to handle critical incidents. Howard SK,  Gaba DM, Fish KJ, Yang G, Sarnquist FH.  Aviat Space Environ Med.  1992; 63 (9): 763-70
• Conference on human error in anesthesia (meeting report). Howard S.K.,  Gaba D.M..  Anesthesiology.  1991; (75): 553-554