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Citation
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Kotagal M, Falcone RAJ, Daugherty M, Merkt B, Klein GL, McDonough S, Boyd SD, Geis GL, Kerrey BT. J. Trauma Acute Care Surg. 2022; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: In today's rapidly changing health care environment, hospitals are expanding into newly built spaces. Preserving patient safety by identifying latent safety threats (LSTs) in advance of opening a new physical space is key to continued excellent care. At our level 1 pediatric trauma center, the hospital undertook a 5-year project to build a critical care tower, including a new emergency department with five trauma bays. To allow for identification and mitigation of LSTs before opening, we performed simulation-based clinical systems testing.
METHODS: Eight simulation scenarios were developed, based on actual patient presentations, incorporating a variety of injury patterns. Scenarios included workflow and movement from the helipad and squad entrance as well as to radiology, the operating room, and the pediatric intensive care unit. A multiple resuscitation scenario was also designed to test the use of all five bays simultaneously. Multidisciplinary high-fidelity simulations were conducted in the new tower. Key trauma and emergency department stakeholders facilitated all sessions, using a structured framework for systems integration debriefing framework and failure mode and effect analysis (FMEA) to identify and prioritize LSTs, respectively.
RESULTS: Eight sessions were conducted over two months. 201 staff participated, including trauma surgeons, respiratory therapists, nurses, emergency physicians, x-ray technicians, pharmacists, emergency medical services, and OR staff. In total, 118 LSTs (average of 14.8/session) were identified. LSTs were categorized. An action plan for mitigation was developed after applying FMEA prioritization scores (based on severity, probability, and ease of detection).
CONCLUSIONS: Systems-focused trauma simulations identified a large number of LSTs before the opening of a new critical care building. Identification of LSTs is feasible and facilitates mitigation before actual patient care begins, improving patient safety. LEVEL OF EVIDENCE: Level IV, Care Management.
Language: en |