Oral Themed Presentation
Context: : Children’s Hospitals and Clinics of Minnesota recently launched a heart transplant and Ventricular Assist Device (VAD) program. The addition of this new program required implementation of transplant-specific practices and policies in addition to developing education opportunities for staff. Our Simulation Center played a key role in the creation and execution of process testing simulations. The concept of process testing simulation was fairly new to our organization; this abstract will specifically address our experiences at the Simulation Center. Additionally it involved key stakeholders who are not typically involved in simulation work. This key stakeholder participation gave our Simulation Center a unique opportunity to showcase a different side of simulation and how it can be effectively used within systems improvement and change.
Description: : Simulation collaborated with our heart transplant coordinator, VAD coordinator, OR staff, and Cardiovascular Intensive Care Unit (CVICU) staff to develop goals and objectives. The objectives enabled our work group to initially identify two process simulation opportunities. Once the processes were identified, key stakeholders were invited to participate. The first process simulation of our pre-transplant process was conducted using a table-top exercise format, other identified process simulations were done in their perspective clinical environments (OR and lab). Observation sheets were developed to help identify process gaps and facilitate the exercise.
Observation/Evaluation: : Observation reports were completed after each simulation including follow-up plans. Participant observation forms were adjusted for each process being tested and used to complete each report. Sessions were recorded to capture all stakeholders contributions. An overall report of findings and accomplishments were presented to transplant leadership once process simulations were completed.
Discussion: : We were able to identify process gaps quite readily with these exercises. In particular, the first process simulation resulted in the development of a third process simulation with lab staff. We realized there were several new processes requiring further testing within the acute care lab space. This included testing new equipment and more transplant-specific education for lab staff.
In addition to the lab process work, we were able to identify improvement opportunities in the pre-op transplant process, including communication of organ acceptance, order entry and room cleaning. The CVICU also refined their pre-op transplant checklists to ensure all necessary tasks are performed prior to surgery. The third process simulation tested our organ verification process in the OR, which resulted in the development of educational tools and the addition of a visual aid in the OR suite to ensure all verification steps are performed properly. This series of process simulations was deemed successful in its accomplishments, however there are certainly lessons learned. First was ensuring we had all of the key stakeholders identified at each exercise, we neglected to invite one helpful department in the first exercise. Second was the development of a clear follow-up plan for certain process gaps that could not be resolved during the exercise.
Utilization of simulation for purposes of process testing proved to be a valuable tool as we begin our transplant journey here at Children's Hospitals and Clinics of Minnesota.