Oral Themed Presentation
Context: : Global Affairs Canada (GAC), provided funding to The Hospital for Sick Children (SickKids) to support the commissioning of the Nelson Mandela Children’s Hospital (NMCH) in South Africa. A significant concern in opening a new hospital is the existence of unrecognized safety threats that could negatively impact patient and staff safety (Kobayashi L, Shapiro MJ, Sucov A, et al, 2006), as well as the hospital’s reputation. Simulation based evaluation was strategically used to assess and understand the space, systems and processes involved in the phasing in of NMCH’s clinical services prior to admitting patients.
Description: : This international project was unique in that most of the preparation work was conducted in Canada and included regular communication with the NMCH team in South Africa. Three separate visits were made to NMCH to develop and implement the simulation evaluation framework which was comprised of (1) A needs assessment, (2) Systems based Simulation Scenarios and Debriefs, (3) Data Collection and Analysis and (4) A Simulation Instructor Course. In July 2016, during the construction phase of the hospital, a needs assessment was conducted that consisted of interviewing healthcare staff from neighboring hospitals. Architectural blueprints of the hospital were also reviewed and potential patient pathways were mapped out using audio and video recordings. In June 2017 four contextual inter-professional simulation scenarios, including an evacuation scenario, were developed and delivered in designated areas of NMCH. The simulations tested the systems, processes and spaces prior to accepting the hospital’s first patients. In February 2018, the team developed and delivered three more contextual inter-professional simulation scenarios that included a Code Blue Event. A total of 72 inter-professional staff participated within the simulations. Each simulation was followed by a debrief where participants were encouraged to provide feedback on hospital system and process issues they had experienced. A Simulation Instructor Workshop was also delivered to 8 pre-selected participants.
Observation/Evaluation: : Evaluation data was collected through the analysis of observations from videotaped simulations and audiotaped debriefs as well as participant surveys. Thematic analysis of data revealed gaps in the patient admission, transfer and discharge process, as well as the emergency preparedness response to an Evacuation and Code Blue event.
Discussion: : Simulations to assess the readiness of a new hospital required detailed and meticulous needs assessments and planning in order to design contextual simulation scenarios, especially when an international team was involved. Engagement with the local team was essential. Inter-professional in-situ simulations with authentic team members enabled the new hires to get to know each other and understand their roles. In addition, they also uncovered safety threats and enabled the development of practice guidelines and processes with improved patient care and potential cost savings.