Traditional Poster Round
Context: : The Radiology department leadership at Children's Minnesota requested the simulation department assist in addressing a potential safety concern. Audits conducted in the radiology department raised awareness regarding adherence to MRI timeout practices. A Simulation-Based Mastery Learning (SBML) curriculum was developed to improve adherence to MRI timeout best practices. MRI technologist performance of MRI timeout was assessed utilizing a standardized participant simulation and checklist. Challenges were embedded within the simulation to assess the participants’ ability to speak up in the face of hierarchy. This was a novel application of SBML with MRI technologists and utilized Lewin's change model to assist with organizational change.
Description: : SBML was utilized as the conceptual framework. After observation of current MRI timeout practice, a simulation scenario utilizing best practice standards for MRI safety was created. Each MRI technologist, on three campuses, was required to complete a standardized participant (SP) simulation. Three SPs played the parent, sedation nurse, and anesthesiologist. Content experts completed a modified Delphi process to develop an assessment tool based on national best practice standards. Minimum passing standard was set utilizing the patient safety method. Standard questions were asked following the simulation to attain perceptions around current MRI timeouts.
Observation/Evaluation: : All MRI technologists met mastery in the first attempt, including embedded challenges for speaking up. Analysis of the responses to the post-simulation questions revealed four themes from each question. Themes for barriers to MRI timeout included: lack of knowledge, lack of engagement, environmental risk, and code blue risks. Themes for what is going well with MRI timeout included: repetitive, compliance, assertive MRI technologist, and process.
Discussion: : Considering we found that all MRI technologists met mastery in the first attempt, safety risk does not appear to come from their ability to adhere to a previously established process. The qualitative data indicates there are other factors that need to be taken into consideration to address patient safety related to MRI timeouts. Following Lewin's change theory, the SP simulation and subsequent questions completed our unfreezing component. During the unfreezing stage, buy-in was developed with the Radiology department and current safety data and risks were shared with staff. In order to include recommendations on possible changes, examination of current education on MRI safety was included in the unfreezing stage. The following stage of Lewin's change theory will be the change stage, which will include our recommendations to update the education plan for the staff outside of the radiology department and to adapt the employee MRI form to include a Code blue safety statement requiring a signed agreement. These recommendations will address many of the themes identified in the interview process.