Simulation-based Clinical Systems Testing of a Pediatric Emergency Department during the COVID-19 Pandemic (1090-004341) (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)
The viral pandemic COVID-19 prompted children’s hospital emergency departments (ED) to prepare for a surge from both pediatric and adult patients. In response, guidelines developed represent “work as imagined” and may not reflect work as done.1-2 In situ simulations could provide the opportunity to fill gaps in education, practice protocols, reduce cognitive load, and help to mitigate errors in times of pressure and exhaustion.1 Simulation-based clinical systems tests (SbCST) are useful to detect gaps and latent safety threats in systems design.2-4 Our aim was to use SbCST combined with rapid cycle training to test hospital system modifications for ED preparation.2-5 If effective this method could represent a new application of SbCSTs. The research questions were in 2 frames: 1. Would front line providers consider rapid SbCSTs acceptable in improving preparedness and 2. Can rapidly deployed SbCSTs identify gaps/latent safety threats and provide recommendations for improvement?
This observational study took place in a children’s hospital ED and was approved by the IRB as a QI project. Our aim was to conduct COVID-19 SbCSTs combined with training. SbCST scenarios were 60 minutes, tested guidelines for workflow, equipment, and care to mitigate potential exposure of staff and patients. We used Gamaurd mannequins and portable tablet-based “monitors” (SimMon). Each case used “tipping-point”(s) in care to emulate workflow changes. Short debriefs reviewed guidelines and staff input, and then staff repeated the simulation. After each simulation, participants using a brief web-based survey to evaluated the SbCST for knowledge (novice to expert), feasibility, acceptability, and suggestions for improvement. Three sim staff observed, reviewed recorded video, and took notes on a standardized form. The reporting process included which guideline/process/job-aide was tested, staff response, any gaps/LSTs identified. A Failure mode event analysis is underway.
22 SbCSTs were conducted with 64 staff, 53 (83%)(17- MDs, 16-RNs, 9-RTs, 7 -Techs, 4- pharmacists) filled out an evaluation. For question 1: Results for evaluation of feasibility (strongly disagree, SD to strongly agree, SA): Worth the time it took: 14% somewhat agreed, 86% strongly agreed. An acceptable way to improve staff readiness/knowledge: 8% somewhat agreed, 92 % strongly agreed. An effective way to test changes/provide solutions, 8% somewhat agreed, 92% strongly agreed. The debriefing process allowed staff to share ideas–average 6.% somewhat agreed 8%, 86% strongly agreed. For question 2: From the 22 simulation sessions staff identified 95 total LSTs. Preliminary results: each LST was categorized for cause as follows: 35 were related to the COVID-19 PPE process, 32 communication/personnel, 15 equipment, and 13 a needed workflow change. A formal failure mode effect analysis (FMEA) is underway and the results from this process will rate each according to FMEA scoring system.
his study demonstrated that simulation-based clinical systems testing (SbCST) methods are adaptable for use in a children’s hospital ED for preparedness evaluation and training. Results from participant evaluations demonstrate a high regard for this method for going through and testing adaptions to the care process required for COVID-19 preparedness. The process detected many LSTs but further data analysis with a formal FMEA process will be required to better understand the results. This work highlights a new application of SbCST that could be applied to increase system preparedness and reduce errors.