Stress Testing the Resuscitation Room: Latent Threats to Patient Safety Identified During Interprofessional In Situ Simulation in a Canadian Academic Emergency Department

George Mastoras; Cari Poulin; Larry Norman; Brian Weitzman; Anita Pozgay; Jason R. Frank; Glenn Posner

doi:10.1002/aet2.10422

0002 Using Multidisciplinary In Situ Simulation in the Emergency Department to Increase Learning and Highlight Potential Patient Safety Issues

10.1136/bmjstel-2014-000002.171 ◽

2014 ◽

Author(s):

Christopher Connolly ◽

Jennie Swift ◽

Anil Hormis ◽

Daniel Stephenson

Keyword(s):

Emergency Department ◽

Patient Safety ◽

In Situ Simulation ◽

Safety Issues ◽

Potential Patient

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In situ simulation in a time of pandemic

The Asia Pacific Scholar ◽

10.29060/taps.2021-6-3/sc2342 ◽

2021 ◽

Vol 6 (3) ◽

pp. 95-98

Author(s):

Shin Ying Thng ◽

Bao Yu Geraldine Leong ◽

Guat Keng Yvonne Goh ◽

Ching Ching Elaine Tan ◽

Jimmy Kock Keng Goh ◽

...

Keyword(s):

Emergency Department ◽

High Risk ◽

Healthcare Team ◽

Risk Environment ◽

Work Processes ◽

In Situ Simulation ◽

Resuscitation Room ◽

Patients At Risk ◽

Set Up

Introduction: Singapore was one of the earliest countries affected by the COVID-19 outbreak, requiring our emergency department to respond urgently to this surge. A designated Fever Area (FA) with a resuscitation room was rapidly set up to manage patients at risk of COVID-19. Our paper describes measures put into this new area to optimise safety outcomes of these patients. Methods: Plan-Do-Study-Act (PDSA) cycles incorporating in-situ simulation in the FA resuscitation room were conducted. Using varied resuscitation scenarios and facilitated debriefing, we identified safety gaps and took immediate steps to rectify them in a collaborative manner involving various respective stakeholders. Results: Following reflective debriefing and studying of work processes, latent safety threats were identified resulting in successful improvements and modifications to protocols, equipment, staffing and processes in the FA resuscitation area. Conclusion: PDSA cycles involving in-situ simulation helped to identify safety threats and refine work processes in a newly set up FA facility. As a result, our healthcare team was more prepared to manage the complexities of COVID-19 patients in a high-risk environment.

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LO044: Stress-testing the resuscitation room: latent threats to patient safety identified during interprofessional in-situ simulation in the emergency department

CJEM ◽

10.1017/cem.2016.81 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S45-S45

Author(s):

G. Mastoras ◽

C. Poulin ◽

L. Norman ◽

B. Weitzman ◽

A. Pozgay ◽

...

Keyword(s):

Emergency Department ◽

Patient Safety ◽

Interprofessional Education ◽

Healthcare Professionals ◽

Tertiary Care ◽

Healthcare Team ◽

Monthly Basis ◽

In Situ Simulation ◽

Training Tool

Introduction: Emergency Department (ED) resuscitation is a complex, high-stakes procedure where positive outcomes depend upon effective interactions between the healthcare team, the patient, and the environment. To this end, resuscitation teams work in spaces designed to optimize workflows and ensure that necessary treatments and skillsets are available when required. However, systematic failures in this environment cannot always be adequately anticipated, exposing patients to opportunities for harm. As part of a new interprofessional education initiative, this prospective, observational study sought to characterize latent threats to patient safety (LST’s) identified during the delivery of in-situ, simulated resuscitations in two Canadian, tertiary care, academic Emergency Departments. Methods: In-situ simulation sessions were delivered on a monthly basis in the EDs of each hospital campus, during which a variety of simulated resuscitation scenarios were run with distinct teams of ED healthcare professionals. A research assistant was present throughout each session and documented LST’s identified by simulation facilitators and participants during the case and debriefing. Data were entered into a master table and grouped thematically for analysis. Results: After a pilot run-in, 10 in-situ simulation sessions were delivered, involving 27 cases and reaching 180 ED healthcare professionals (25 attending MD, 37 resident MD, 59 RN, 24 RT). 83 latent safety threats were identified through these sessions (mean 3.1 LSTs per case) of which 52 were determined to be “actionable”. Corrective mechanisms have been initiated in 72% of these cases (e.g., new education campaigns and in-servicing, equipment provisioning, equipment checklists). Conclusion: In-situ simulation, beyond its role as a training tool for developing Non-Technical and Crisis Resource Management skills, can be effectively used to identify systematic deficits and knowledge gaps that could expose critically ill patients to harm. Effective quality improvement and continuing education programs are essential to translate these findings into more resilient patient care.

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IMPROVING SYSTEM READINESS, STAFF PREPAREDNESS AND PATIENT SAFETY IN A NEW SINGLE FAMILY ROOM NICU THROUGH IN SITU SIMULATION

Paediatrics & Child Health ◽

10.1093/pch/pxy054.042 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e16-e16

Author(s):

Ahmed Moussa ◽

Audrey Larone-Juneau ◽

Laura Fazilleau ◽

Marie-Eve Rochon ◽

Justine Giroux ◽

...

Keyword(s):

Patient Safety ◽

Repeated Measures ◽

Large Scale ◽

Multidisciplinary Teams ◽

Single Family ◽

In Situ Simulation ◽

Ensure Patient Safety ◽

System Readiness ◽

Dependent Samples

Abstract BACKGROUND Transitions to new healthcare environments can negatively impact patient care and threaten patient safety. Immersive in situ simulation conducted in newly constructed single family room (SFR) Neonatal Intensive Care Units (NICUs) prior to occupancy, has been shown to be effective in testing new environments and identifying latent safety threats (LSTs). These simulations overlay human factors to identify LSTs as new and existing process and systems are implemented in the new environment OBJECTIVES We aimed to demonstrate that large-scale, immersive, in situ simulation prior to the transition to a new SFR NICU improves: 1) systems readiness, 2) staff preparedness, 3) patient safety, 4) staff comfort with simulation, and 5) staff attitude towards culture change. DESIGN/METHODS Multidisciplinary teams of neonatal healthcare providers (HCP) and parents of former NICU patients participated in large-scale, immersive in-situ simulations conducted in the new NICU prior to occupancy. One eighth of the NICU was outfitted with equipment and mannequins and staff performed in their native roles. Multidisciplinary debriefings, which included parents, were conducted immediately after simulations to identify LSTs. Through an iterative process issues were resolved and additional simulations conducted. Debriefings were documented and debriefing transcripts transcribed and LSTs classified using qualitative methods. To assess systems readiness and staff preparedness for transition into the new NICU, HCPs completed surveys prior to transition, post-simulation and post-transition. Systems readiness and staff preparedness were rated on a 5-point Likert scale. Average survey responses were analyzed using dependent samples t-tests and repeated measures ANOVAs. RESULTS One hundred eight HCPs and 24 parents participated in six half-day simulation sessions. A total of 75 LSTs were identified and were categorized into eight themes: 1) work organization, 2) orientation and parent wayfinding, 3) communication devices/systems, 4) nursing and resuscitation equipment, 5) ergonomics, 6) parent comfort; 7) work processes, and 8) interdepartmental interactions. Prior to the transition to the new NICU, 76% of the LSTs were resolved. Survey response rate was 31%, 16%, 7% for baseline, post-simulation and post-move surveys, respectively. System readiness at baseline was 1.3/5,. Post-simulation systems readiness was 3.5/5 (p = 0.0001) and post-transition was 3.9/5 (p = 0.02). Staff preparedness at baseline was 1.4/5. Staff preparedness post-simulation was 3.3/5 (p = 0.006) and post-transition was 3.9/5 (p = 0.03). CONCLUSION Large-scale, immersive in situ simulation is a feasible and effective methodology for identifying LSTs, improving systems readiness and staff preparedness in a new SFR NICU prior to occupancy. However, to optimize patient safety, identified LSTs must be mitigated prior to occupancy. Coordinating large-scale simulations is worth the time and cost investment necessary to optimize systems and ensure patient safety prior to transition to a new SFR NICU.

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Patient safety culture improves during an in situ simulation intervention: a repeated cross-sectional intervention study at two hospital sites

BMJ Open Quality ◽

10.1136/bmjoq-2020-001183 ◽

2021 ◽

Vol 10 (1) ◽

pp. e001183

Author(s):

Anders Schram ◽

Charlotte Paltved ◽

Karl Bang Christensen ◽

Gunhild Kjaergaard-Andersen ◽

Hanne Irene Jensen ◽

...

Keyword(s):

Patient Safety ◽

Safety Culture ◽

Intervention Study ◽

Patient Safety Culture ◽

Cross Sectional ◽

In Situ Simulation ◽

Culture Dimensions ◽

Scale Scores ◽

Safety Attitude

ObjectivesThis study aimed to investigate staff’s perceptions of patient safety culture (PSC) in two Danish hospitals before and after an in situ simulation intervention.DesignA repeated cross-sectional intervention study.SettingTwo Danish hospitals. Hospital 1 performs emergency functions, whereas hospital 2 performs elective functions.ParticipantsA total of 967 healthcare professionals were invited to participate in this study. 516 were employed in hospital 1 and 451 in hospital 2. Of these, 39 were trained as simulation instructors.InterventionA 4-day simulation instructor course was applied. Emphasis was put on team training, communication and leadership. After the course, instructors performed simulation in the hospital environment. No systematic simulation was performed prior to the intervention.Main outcome measuresThe Safety Attitude Questionnaire investigating PSC was applied prior to the intervention and again 4 and 8 weeks after intervention. The proportion of participants with a positive attitude and mean scale scores were measured as main outcomes.ResultsThe response rate varied from 63.6% to 72.0% across surveys and hospitals. Baseline scores were generally lower for hospital 1. The proportion of staff with positive attitudes in hospital 1 improved by ≥5% in five of six safety culture dimensions, whereas only two dimensions improved by ≥5% in hospital 2. The mean scale scores improved significantly in five of six safety culture dimensions in hospital 1, while only one dimension improved significantly in hospital 2.ConclusionsSafety attitude outcomes indicate an improvement in PSC from before to after the in situ simulation intervention period. However, it is possible that an effect is more profound in an acute care hospital versus an elective setting.

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