Simulation-based Testing of a New Helipad Using an Iterative Failure Mode and Effects Analysis Framework (1090-003916) (Research Abstract Oral: QI)
Start time: Monday, January 25, 2021, 2:00 PM End time: Monday, January 25, 2021, 3:00 PM Session Type: Research Abstracts (Completed Studies)
Fundamental changes in critical systems, such as spaces within hospitals, present safety risks. Some of these threats can be identified prospectively, others are latent and are only uncovered once the system goes live. Simulation provides the opportunity to test a system without endangering patients. There is a growing body of healthcare literature describing the use of simulation programs to test and improve new hospitals or units within hospitals prior to opening [1,2] however none describing the use of simulation to probe a new helicopter landing pad system. Failure mode effect analysis (FMEA) is an approach developed by the U.S. Military in the 1940’s to identify possible failures in a design or process. The ‘effect analysis’ component studies the consequences of the failures. We proposed that the FMEA process can be effectively coupled with simulation to find and mitigate potential safety threats in a new hospital helicopter landing pad system.
This simulation study was conducted in three phases. In Phase 1, an interprofessional group of stakeholders created a process map, identifying steps that would likely be impacted by the opening of the new helipad. Using a Failure Mode Effect Analysis based Systems Testing Scorecard, each potential failure mode was assigned a hazard score based on its estimated likelihood of occurring and severity of impact on patient safety/or staff experience. Phase II used low fidelity simulation to focus on communications, registration, admitting procedures, and to identify the best paths of travel from the helipad to the most common hospital destinations. In Phase III, high fidelity simulation testing, including landing of two helicopters, was used to probe safety threats identified in earlier phases, including: 1) limited security escort services with near simultaneous patient landings, 2) communication to receiving units, and 3) procedure for a patient who decompensates during transfer.
Over the three phases of simulation systems testing, 28 potential latent safety threats, 25% of which were both high risk and high likelihood, were identified in areas of care coordination, facilities, equipment and devices, and teamwork. Number of threats detected decreased in each subsequent phase (15 in I, 7 in II, and 6 in III). Phase three failure modes included lack of second page to ICU or PICU once a helicopter lands, registration communication, failure to meet registration with the new path of travel, lack of additional security escort during simultaneous landings, helipad icing safety hazard, emergency medicine physician not having access to helipad, patient decompensates pre-arrival, and patient decompensates in hospital during transport.
In conclusion, we found an iterative three-phase simulation systems testing program using FMEA methodology to be an effective tool to develop new helipad workflows and identify and mitigate latent safety threats.