Current Anaesthesia & Critical Care (2005) 16, 273–281 Focus on: The Role of Medical Simulation Simulation and patient safety: The use of simulation to enhance patient safety on a systems level Marcus Rall à , Peter Dieckmann Center for Patient Safety and Simulation TuPASS, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tuebingen, D-72074 Tuebingen, Germany KEYWORDS Medical education; Patient simulation; Crisis resource man- agement (CRM); Medical errors; Patient safety Summary Errors in healthcare feature in the 10 leading causes of death. The identification of the sources of such errors and the development of countermeasures whether against errors made by individuals or errors occurring due to latent conditions at system level are the key strategies in tackling this large problem. Simulation-based teaching can make meaningful contributions to this process in many ways and at many levels. At the level of the individual healthcare professional simulated clinical scenarios can raise awareness of the nature of the problem and demonstrate the relevance and need for training in a crew resource management type of course. At the level of an anaesthetic department such courses can help provide a common approach to problems in an area neglected by traditional teaching and so improve communication in this area. The use of simulation also extends to research and development. Study of the use of key resources, such as personnel or equipment, under stressful conditions in a simulated environment can help not only detect possible sources of error but can also help develop strategies to provide effective specific countermeasures. & 2005 Elsevier Ltd. All rights reserved. Introduction Patient safety and its systems perspective have become one of the top issues in healthcare in the last few years. 1,2 No diagnosis has ever been so much neglected as the diagnosis ‘error in health- care’, which is nowadays known to be among the 10 leading causes of death. The medical domain had to overcome decades of inactivity regarding the implementation of systematic safety methods (e.g. incident reporting, root-cause analysis, etc.), issues which have been tackled by other high-risk high-reliability organizations for more than 40 years. Anaesthesia was, and perhaps still ARTICLE IN PRESS www.elsevier.com/locate/cacc 0953-7112/$ - see front matter & 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.cacc.2005.11.007 à Corresponding author. Tel.: +497071 2986564; fax: +49 7121 241319. E-mail addresses: marcus.rall@med.uni-tuebingen.de (M. Rall), peter.dieckmann@med.uni-tuebingen.de(P. Dieckmann). URL: http://www.medizin.uni-tuebingen.de/psz/.