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Making a Move: Using Simulation to Identify Latent Safety Threats to the Care of Injured Patients in a New Physical Space
*Meera Kotagal, *Richard A. Falcone, Jr., *Margot Daugherty, Brant Merkt, Gina L. Klein, Shawn McDonough, Stephanie D. Boyd, Gary L. Geis, Benjamin T. Kerrey
Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Background:
In today’s rapidly changing health care environment, hospitals are expanding into newly built spaces. Preserving patient safety by identifying latent safety threats (LSTs) in advance of opening a new physical space is key to continued excellent care. At our level 1 pediatric trauma center, the hospital undertook a 5-year project to build a critical care tower, including a new emergency department with five trauma bays. To allow for identification and mitigation of LSTs before opening, we performed simulation-based clinical systems testing.
Methods:
Seven simulation scenarios were developed, based on actual patient presentations, incorporating a variety of injury patterns. Scenarios included workflow and movement from the helipad and squad entrance as well as to radiology, the operating room, and the pediatric intensive care unit. A multiple resuscitation scenario was also designed to test the use of all five bays simultaneously. Multidisciplinary high-fidelity simulations were conducted in the new tower. Key trauma and emergency department stakeholders facilitated all sessions, using PEARLS for systems integration debriefing framework and failure mode and effect analysis (FMEA) to identify and prioritize LSTs, respectively.
Findings:
Eight sessions were conducted over two months. 201 staff participated, including trauma surgeons, respiratory therapists, nurses, emergency physicians, x-ray technicians, pharmacists, emergency medical services, and OR staff. In total, 158 LSTs (average of 19.8/session) were identified. LSTs were categorized (Figure 1). An action plan for mitigation was developed after applying FMEA prioritization scores (based on severity, probability and ease of detection).
Conclusions:
Systems-focused trauma simulations identified a large number of LSTs before the opening of a new critical care building. Identification of LSTs is feasible and facilitates mitigation before actual patient care begins, improving patient safety.


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