Award Candidate Poster Presentation


Implementing Rapid Response Team Training Simulations to Improve Patient Safety in a Satellite Hospital

Tuesday, May 15
09:45 - 10:45
Location: Jupiter 1&2

Context: : In 2007, we opened a free standing satellite hospital 12 miles from the main hospital facility with 11 inpatient beds, 6 operating rooms and comprehensive outpatient multidisciplinary medical and surgical care. Over the last 10 years, the facility has expanded to include rapidly increasing numbers of outpatient visits, increasingly complex care and expanded hours in our Infusion Unit, and the addition of a stepdown inpatient psychiatric unit. An Anesthesiology/Critical Care Medicine hospitalist team was created to provide 24/7 physician coverage for both inpatient postsurgical care and rapid response for urgent and emergent events within the hospital. The number of calls for both medical and behavioral issues has increased exponentially over the last 10 years and included 174 activations in FY 2017.

Description: : The Rapid Response Team (RRT) for our satellite facility is led by a Hospitalist and Nurse Manager. It includes nurses from the Inpatient Unit, Radiology, Infusion Unit, Postoperative Anesthesia Care Unit (PACU) and Social Work staff. Since the members of this group do not work with each other regularly but must assemble quickly and efficiently at times of emergency, we developed an on-site Crisis Resource Management Simulation program to both improve emergency preparedness and develop effective teamwork among these ad-hoc teams. The course was developed in conjunction with the Boston Children’s Hospital SIMPeds program and is supported by a mobile truck, advanced debriefing and team performance expertise, a bioengineer and high fidelity mannequins with sophisticated computerized systems able to create a realistic on-site simulation space within the facility.

Observation/Evaluation: : During the last two years, a total of 12 high-fidelity satellite simulation courses were conducted utilizing on-site teams with at least one member from each department represented on the Satellite RRT. Courses were developed based on ongoing data collection of all rapid response calls and represented the most common scenarios encountered. These courses have provided practice in rapidly developing the 5 crisis resource management skills of role clarity, communication, personnel support, resources and global assessment/situational awareness and have been crucial in identifying team-level knowledge deficits, latent safety threats and system-level issues and to define areas for process improvement. The lessons learned from each course have been used to create additional skills practice sessions, department-specific mock codes, tabletop discussions, equipment upgrades and improved medication availability.

Discussion: : Utilizing a mobile high fidelity simulation program, we developed a crisis resource management program in our satellite hospital to improve patient safety and emergency preparedness. This program has not only provided effective learning for the members of these ad-hoc RRT’s but also identified many latent safety threats and system-level issues used for ongoing skills training and performance improvement activities. Surveys performed after the simulation sessions have demonstrated increased awareness of crisis resource management principles and evidence of reflective learning. The simulation sessions have also created excitement among team members around the development of process improvement activities.

Constance Houck, MD, MPH

Senior Associate in Perioperative Anesthesia
Boston Children's Hospital
Boston, Massachusetts

Constance S. Houck, MD, MPH, FAAP

Dr. Houck is a Senior Associate in Perioperative Anesthesia at Boston Children’s Hospital and an Associate Professor of Anaesthesia at Harvard Medical School. She completed training in Pediatrics, Anesthesiology and Pediatric Critical Care Medicine and currently serves as the Clinical Director of the Hospitalist program and co-director of the Rapid Response Team at Boston Children’s Hospital at Waltham. As a pediatric anesthesiologist and surgical hospitalist, Dr. Houck provides care to children throughout the perioperative period – providing preoperative evaluation and preparation, intraoperative anesthesia and postoperative hospital-based care. She has been able to leverage her acute care and critical care skills to help build a multidisciplinary Rapid Response Team to provide urgent and emergent care for all children cared for in this satellite hospital located 12 miles away from the main hospital facility. In addition, as part of hospital-wide quality improvement efforts, she has co-created a simulation program in collaboration with the Boston Children’s Hospital SIMPeds™ program to provide ongoing training and support for the members of the BCH Waltham Rapid Response Team.

For the last 20 years, Dr. Houck has played an active role in advocating for safe and effective perioperative and acute care for children through her many activities with the American Academy of Pediatrics (AAP). She currently serves as the Chair of the AAP, Surgical Advisory Panel and was a key member of the Task Force on Children’s Surgical Care that led to the development of the standards for the American College of Surgeons Children’s Surgery Verification and Quality Improvement program (ACS CSV). She represents the entire pediatric anesthesiology community as one of just 2 pediatric anesthesiologists on the ACS CSV Verification Committee and is actively involved in efforts to improve perioperative quality and safety at BCH and throughout the country. She is a strong advocate for multidisciplinary team training through simulation and adult learning methods.


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Cynthia Gardell, MS, MBA, RN, NEA-BC

Nurse Manager, Inpatient Unit and Radiology
Boston Children's Hospital at Waltham
Waltham, Massachusetts

Cindy Gardell RN, MSN, MBA, NE-BC
Cindy is the Nurse Manager of Inpatient and Radiology Nursing in a Satellite location for Boston Children’s Hospital USA
She is an Associate Clinical Director of Satellite SIMPeds and a Co-Chair of the Satellite Rapid Response Team.
Cindy's 38 years of nursing experience spans critical care, inpatient, ambulatory and procedural areas for both pediatric and adult patients.
She works closely with the Executive Director of Satellite Operations and the Director of the Hospitalist Program & MD Co-Chair of the Rapid Response Team to ensure patient safety and quality care in an efficient and highly reliable environment with a sharp focus on continuous evaluation and development of resources, competencies and interprofessional collaboration


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Julee Bolg, MS, MBA, RN, NEA-BC

Executive Director, Satellite Clinical Operations
Boston Children's Hospital, Massachusetts


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Matthew Taylor, RN

Faculty Development Educator
Boston Children's Hospital Simulator Program


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Christopher Roussin, PhD

Director of Academics and Research
Boston Children's Hospital Simulator Program

Chris Roussin is Academic and Research Director of the Simulator Program at Boston Children's Hospital and faculty member at Harvard Medical School in the Department of Anesthesiology, Perioperative and Pain Medicine. He is a leader, teacher and researcher of team performance and learning, an experienced change leader, and a leader in the development and delivery of simulation-based learning programs and systems. His research is published in Journal of Management, Academic Medicine, Journal of Applied Psychology, and a number of other outlets.


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Implementing Rapid Response Team Training Simulations to Improve Patient Safety in a Satellite Hospital


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