Oral Themed Presentation
Context: : New construction and remodeling is common in modern day hospitals. The built environment’s interface with personnel, patients, equipment, technology impacts patient safety. The process of evaluating a newly built space for latent safety threats (LSTs) is not standardized. The integration of simulated-based clinical systems testing (SbCST) with Failure Mode Effect Analysis (FMEA) allows for multidisciplinary teams to interact with their built environment to identify LSTs, evaluate workflow and high-risk processes and mitigate threats prior to patient exposure.
Description: : SbCST was implemented prior to the opening of our Center for Advanced Pediatrics (CAP), a newly constructed subspecialty clinic. The conceptual model focused on principles for safe hospital design; standardization, staff efficiency, communication, infection control, and patient/ family experience. Simulated scenarios included routine situations encountered with high frequency as well as low frequency high-risk scenarios pertinent to the clinic patient population. Each simulation was followed by a debrief. During the debrief LSTs were identified by participants and observers. Each issue identified was assigned a severity, occurrence and detection score which was multiplied together to determine a risk priority number (RPN). This was used to categorize and prioritize each issue.
Observation/Evaluation: : 31 simulated scenarios were conducted for 15 distinct subspecialty clinics over 3 months. 211 staff members participated in simulations. 334 LSTs were identified. Of those identified 80 were resource issues, 131 facility issues, and 123 were process/workflow issues. 36 LSTs were characterized as very high priority, 23 high priority, 49 medium priority and 226 were low priority. 26 items were found to be common to all subspecialty areas. Common themes included process related to activation of an emergency response, wayfinding, location of PPE, and workflow related to movement of patients through the clinic. Accountability and identification of action items were left to individual clinic stakeholder groups to discuss separate from the debrief.
Discussion: : We describe an innovative application of how simulation and FMEA can be applied as a risk assessment strategy to evaluate how the built environment impacts patient safety, workflow, and high-risk processes. The integration of simulation with FMEA risk assessment is a more efficient way to evaluate the built environment, identify LSTs, and potentially mitigate threats prior to patient interface. The identification of over 300 LSTs demonstrate how SbCST can be used to detect failure modes. Success of testing depends on leadership guidance to build testing objectives, engage participants, and maintain accountability for implementing change. Opportunity exists amongst the simulation community to standardize this process and influence how healthcare facilities are built and tested. Further research is needed to evaluate methodology and impact of this type of testing.