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Impact Of Simulation-based Clinical Systems Testing On Transition To An Independent Pediatric Trauma Center
Sacha Williams, Jennifer Arnold, Katie Fitzpatrick, *Christopher Snyder
Johns Hopkins All Children's Hospital, St Petersburg, FL

Background: Simulation has shown benefit in many areas of medicine, but the balance of financial cost and benefit in pediatric trauma is unclear. Our institution recently underwent major workflow changes in becoming an independent pediatric trauma center. We used a systematic Simulation-Based Clinical Systems Testing (SbCST) approach to manage change-associated risks. The purpose of this study was to evaluate the impact of SbCST, focusing on its financial costs and benefits.
Methods: SbCST consisted of the following steps: 1) change-based needs assessment, in which stakeholders developed relevant simulation scenarios, 2) scenario implementation, and 3) post-simulation failure mode and effects analysis (FMEA) to identify latent safety threats (LSTs). LSTs were then prioritized for mitigation, based on the expected frequency and severity of adverse event occurrence. Costs associated with SbCST were calculated. Since no standardized method exists to estimate SbCST cost savings, we conservatively estimated cost savings using three approaches: 1) FMEA-based avoidance of adverse events, 2) avoidance of trauma readmissions, and 3) avoidance of medical liability lawsuits.
Results: Two simulation scenarios were developed and implemented pre-change. FMEA revealed 49 LSTs, of which 9 were highest priority (catastrophic severity, high likelihood of occurrence). Cost-benefit analysis based on FMEA event avoidance demonstrated net cost savings to the institution ranging from $52,000-227,000 over the 3-month post-change period. Readmission-based and liability-based estimates produced similarly favorable results.
Conclusions: The SbCST approach identified multiple high-impact safety risks and was financially beneficial to the institution. SbCST is a cost-effective tool for managing process changes in pediatric trauma care.


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