Resilience in the Midst of a Pandemic: In Situ Simulation to Evaluate COVID-19 Preparedness at a Pediatric Health System in New England (1090-002414) (To be presented in the session entitled, Research Abstract Oral: COVID-19)
Start time: Friday, January 22, 2021, 2:00 PM End time: Friday, January 22, 2021, 3:00 PM Session Type: Research Abstracts (Completed Studies)
The science of human factors and ergonomics (HFE) has the primary goal of optimizing technology design and care systems to achieve productivity, safety, efficiency, and quality in the care delivery process (1). Using mixed-methods research, healthcare simulation provides a platform on which to evaluate the impact of organizational design, policies, procedures on an individual or team performance, and safety through the human-centered design approach (2). This pediatric health system employed a multidisciplinary, inter-professional task force to evaluate preparedness levels. In parallel, the simulation program performed systems integration simulations to inform one patient’s journey through the institution. The primary purpose of the sessions was to assess and inform the status of preparedness in each area concerning COVID-19. A second purpose was to provide an outlet to express underlying apprehensions, and reveal the problem solving/resilient abilities inherent to the system.
In keeping with the human-centered design to systems integration, the simulation team invited an inter-professional and multidisciplinary collaborative group to help develop, and facilitate the simulation sessions. Existing practices were evaluated for readiness and adaptation by utilizing one primary scenario involving a 5-year-old meeting the initial patient under investigation (PUI) case definition - as she progressed from emergency department assessment to definitive management with ECMO. In parallel to institutional progression, an iterative approach was employed to session delivery, and the original scenario was adapted to embody specific patient populations or to assess newly developed practices. Debriefings utilized the PEARLS Systems Focused Debriefing process and were mapped to our institutional report out tool. A modified risk severity score was developed regarding staff comfort with the established solution, and anticipated work required to address issues.
Results A total of 209 issues were investigated during the debriefings of the 10 sessions. Staff endorsed comfort with 44 of the solutions devised during the debriefing, or previously established (21.3%). Minor feasibility confirmations were required for an additional 88 issues (42.5%). A moderate amount of discussion was necessary for 65 (31.4%) of the issues, while only 10 (4.83%) issues required further evaluation and correction by stakeholders and workgroup leaders. Findings revealed during the debriefing sessions were mapped to 7 of 9 assessment areas highlighted by the CDC document regarding hospital preparedness for COVID-19. Accordingly, these findings directly informed multiple institutional policies and procedures.
Systems Integration simulations were relatively comprehensive in their ability to identify, address, and reaffirm the COVID-19 preparedness process. Solutions developed a priori, or de novo during the simulation process were well matched to the needs of the frontline staff 63.8% of the time. Complete solution innovation was necessary for less than 5% of the time. This substantiates that systems integration simulations can not only identify latent safety issues, but also the resilience of the system, and the individuals that work within it.