Bio

Bio


My interest is in improving systems practice, quality improvement, and patient safety, often utilizing various tools from medical simulation that can translate to clinical changes. Most recently, I have collaborated with Stanford and national colleagues on implementation of emergency manuals (context relevant sets of cognitive aids or checklists), for crisis management of critical events. See http://emergencymanual.stanford.edu and www.emergencymanuals.org with more details below.

Clinical Focus


  • Anesthesia

Academic Appointments


Professional Education


  • Internship:Brigham and Women's Hospital Harvard Medical School (2004) MA
  • Fellowship, Center for Medical Simulation, Harvard, Simulation (2007)
  • Board Certification: Anesthesia, American Board of Anesthesiology (2009)
  • Residency:Massachusetts General Hospital (2007) MA
  • Medical Education:Harvard Medical School (2003) MA

Research & Scholarship

Current Research and Scholarly Interests


My current interest is in implementation of emergency manuals (context relevant sets of cognitive aids or checklists) and other system-wide mechanisms to help excellent clinicians to deliver optimal care during critical events. Harnessing various forms of medical simulation as a development, research, and training mechanism has the potential to improve patient safety. My interests include:
1. Implementation of emergency manuals for crisis management of critical events, in both simulation-based and clinical settings
See http://emergencymanual.stanford.edu as a website I developed, sharing the work of our Stanford Anesthesia Cognitive Aid Group as well as our interdisciplinary clinical implementation team. See www.emergencymanuals.org for the website of the Emergency Manuals Implementation Collaborative, which a group of us founded to foster implementation by sharing resources nationally as well as internationally.
2. Teaching Supervisory experience to anesthesia residents via simulation - Director of Stanford's Evolve simulation program, integrating Crisis Resource Management techniques with supervisory practice and reflection.
3. Utilizing high fidelity simulation along with debriefing to teach principles of Crisis Resource Management (CRM)
4. Utilizing low-tech verbal 'What If's' and simple screen-based simulation to harness the power of simulation and debriefing in much wider, more frequent, and even clinical settings.
4. Improving formative feedback for trainees by applying methods adapted from education literature and organizational behavior.
5. Difficult airway management, and ENT anesthesia, integrating procedural and full-scenario simulation to practice and debrief approaches to challenging cases.

Publications

Journal Articles


  • Implementing emergency manuals: can cognitive AIDS help translate best practices for patient care during acute events? Anesthesia and analgesia Goldhaber-Fiebert, S. N., Howard, S. K. 2013; 117 (5): 1149-1161

    Abstract

    In this article, we address whether emergency manuals are an effective means of helping anesthesiologists and perioperative teams apply known best practices for critical events. We review the relevant history of such cognitive aids in health care, as well as examples from other high stakes industries, and describe why emergency manuals have a role in improving patient care during certain events. We propose 4 vital elements: create, familiarize, use, and integrate, necessary for the widespread, successful development, and implementation of medical emergency manuals, using the specific example of the perioperative setting. The details of each element are presented, drawing from the medical literature as well as from our combined experience of more than 30 years of observing teams of anesthesiologists managing simulated and real critical events. We emphasize the importance of training clinicians in the use of emergency manuals for education on content, format, and location. Finally, we discuss cultural readiness for change, present a system example of successful integration, and highlight the importance of further research on the implementation of emergency manuals.

    View details for DOI 10.1213/ANE.0b013e318298867a

    View details for PubMedID 24108251

  • Simulation Exercises as a Patient Safety Strategy A Systematic Review ANNALS OF INTERNAL MEDICINE Schmidt, E., Goldhaber-Fiebert, S. N., Ho, L. A., McDonald, K. M. 2013; 158 (5): 426-?

    Abstract

    Simulation is a versatile technique used in a variety of health care settings for a variety of purposes, but the extent to which simulation may improve patient safety remains unknown. This systematic review examined evidence on the effects of simulation techniques on patient safety outcomes. PubMed and the Cochrane Library were searched from their beginning to 31 October 2012 to identify relevant studies. A single reviewer screened 913 abstracts and selected and abstracted data from 38 studies that reported outcomes during care of real patients after patient-, team-, or system-level simulation interventions. Studies varied widely in the quality of methodological design and description of simulation activities, but in general, simulation interventions improved the technical performance of individual clinicians and teams during critical events and complex procedures. Limited evidence suggested improvements in patient outcomes attributable to simulation exercises at the health system level. Future studies would benefit from standardized reporting of simulation components and identification of robust patient safety targets.

    View details for Web of Science ID 000316058600010

    View details for PubMedID 23460100

  • Trigger Video of Simulated Intraoperative Cardiac Arrest. MedEdPORTAL Goldhaber-Fiebert, S., Harrison K, Mudumbai S, Howard S, McCowan K, Gaba D 2010
  • Knowledge-based errors in anesthesia: a paired, controlled trial of learning and retention CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE Goldhaber-Fiebert, S. N., Goldhaber-Fiebert, J. D., Rosow, C. E. 2009; 56 (1): 35-45

    Abstract

    Optimizing patient safety by improving the training of physicians is a major challenge of medical education. In this pilot study, we hypothesized that a brief lecture, targeted to rare but potentially dangerous situations, could improve anesthesia practitioners' knowledge levels with significant retention of learning at six months.In this paired controlled trial, anesthesia residents and attending physicians at Massachusetts General Hospital took the same 14-question multiple choice examination three times: at baseline, immediately after a brief lecture, and six months later. The lecture covered material on seven "intervention" questions; the remaining seven were "control" questions. The authors measured immediate knowledge acquisition, defined as the change in percentage of correct answers on intervention questions between baseline and post-lecture, and measured learning retention as the difference between baseline and six months. Both measurements were corrected for change in performance on control questions.Fifty of the 89 subjects completed all three examinations. The post-lecture increase in percentage of questions answered correctly, adjusted for control, was 22.2% [95% confidence interval (CI) 16.0-28.4%; P < 0.01], while the adjusted increase at six months was 7.9% (95% CI 1.1-14.7%; P = 0.024).A brief lecture improved knowledge, and the subjects retained a significant amount of this learning at six months. Exposing residents or other practitioners to this type of inexpensive teaching intervention may help them to avoid preventable uncommon errors that are rooted in unfamiliarity with the situation or the equipment. The methods used for this study may also be applied to compare the effect of various other teaching modalities while, at the same time, preserving participant anonymity and making adjustments for ongoing learning.

    View details for DOI 10.1007/s12630-008-9002-9

    View details for Web of Science ID 000263012800006

    View details for PubMedID 19247776

  • Male involvement in cardiovascular preventive healthcare in two rural Costa Rican communities PREVENTIVE MEDICINE Goldhaber-Fiebert, J. D., Goldhaber-Fiebert, S. N., Andorsky, D. J. 2005; 40 (6): 690-695

    Abstract

    Gender differences in health system usage can lead to differences in the incidence of morbidity and mortality. We conducted a pilot screening targeted towards men to evaluate gender differences in cardiovascular disease risk factor detection and time since last clinic visit.Three evening sessions in two communities screened 148 people, mean age 47.7 years. Height, weight, body mass index, blood pressure, blood glucose, and total cholesterol were measured. A questionnaire on past medical history was administered. Participants with elevated measurements were referred to appropriate care.Men accounted for 60.1% of those screened; 65.5% of the group was overweight, and 22.3% was obese with 42.6% hypertension, 39.2% hypercholesterolemia, and 2.7% high blood glucose. Among men aged 35 to 65, 65.2% were overweight, 20.3% obese, 46.4% hypertensive, 42.0% hypercholesterolemic, and 1.5% with high blood glucose. Within the last 2 years, 53.3% of men and 9.1% of women aged 35 to 65 had not visited a doctor (P = 0.004).A significant portion of those screened had elevated cardiovascular disease risk factors. Given that men visited doctors significantly less frequently, efforts to involve men in prevention of cardiovascular disease within these communities are warranted.

    View details for DOI 10.1016/j.ypmed.2004.09.009

    View details for Web of Science ID 000229006700011

    View details for PubMedID 15850866

  • Randomized controlled community-based nutrition and exercise intervention improves glycemia and cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica DIABETES CARE Goldhaber-Fiebert, J. D., Goldhaber-Fiebert, S. N., Tristan, M. L., Nathan, D. M. 2003; 26 (1): 24-29

    Abstract

    The prevalence of type 2 diabetes, especially in developing countries, has grown over the past decades. We performed a controlled clinical study to determine whether a community-based, group-centered public health intervention addressing nutrition and exercise can ameliorate glycemic control and associated cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica.A total of 75 adults with type 2 diabetes, mean age 59 years, were randomly assigned to the intervention group or the control group. All participants received basic diabetes education. The subjects in the intervention group participated in 11 weekly nutrition classes (90 min each session). Subjects for whom exercise was deemed safe also participated in triweekly walking groups (60 min each session). Glycosylated hemoglobin, fasting plasma glucose, total cholesterol, triglycerides, HDL and LDL cholesterol, height, weight, BMI, and blood pressure were measured at baseline and the end of the study (after 12 weeks).The intervention group lost 1.0 +/- 2.2 kg compared with a weight gain in the control group of 0.4 +/- 2.3 kg (P = 0.028). Fasting plasma glucose decreased 19 +/- 55 mg/dl in the intervention group and increased 16 +/- 78 mg/dl in the control group (P = 0.048). Glycosylated hemoglobin decreased 1.8 +/- 2.3% in the intervention group and 0.4 +/- 2.3% in the control group (P = 0.028).Glycemic control of type 2 diabetic patients can be improved through community-based, group-centered public health interventions addressing nutrition and exercise. This pilot study provides an economically feasible model for programs that aim to improve the health status of people with type 2 diabetes.

    View details for Web of Science ID 000185504900004

    View details for PubMedID 12502654

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