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Simulation-Based System Analysis: Testing Preparedness for Extracorporeal Membrane Oxygenation Cannulation in
Alyssa C Stoner1, Robert D Schremmer2, Mikaela A Miller3
1Department of Pediatrics Critical Care Division, Children's Mercy Hospitals and Clinics, Kansas City, Mo.
Pediatric Quality & Safety
|January 24, 2022
Summary
Simulation-based Clinical Systems Testing (SbCST) identified numerous latent safety threats during extracorporeal membrane oxygenation (ECMO) and extracorporeal cardiopulmonary resuscitation (eCPR) procedures. This framework helped develop strategies to reduce patient and staff exposure to COVID-19.
Area of Science:
- Medical Simulation
- Patient Safety
- Healthcare Systems Engineering
Background:
- Coronavirus Disease-2019 (COVID-19) poses risks during complex procedures like ECMO/eCPR.
- High-fidelity simulations are crucial for identifying safety threats in critical care settings.
Observation:
- A Simulation-based Clinical Systems Testing (SbCST) framework was adapted and deployed during the pandemic.
- Simulations evaluated six key domains: Resources, Processes/Systems, Facilities, Clinical Performance, Infection Control, and Communication.
Findings:
- Sixty-six latent safety threats (LSTs) were identified across three high-fidelity simulations.
- Resource, Process/System, and Infection Control issues were the most frequent LST categories.
- New strategies, including a "door/PPE monitor" and distinct "inside/outside" team roles, were developed.
Implications:
- The SbCST framework effectively identified LSTs related to ECMO/eCPR and infection control during COVID-19.
- Developed guidelines conserve PPE and optimize workflows to minimize patient/staff exposure.
- This approach can guide other institutions in adapting SbCSTs for rapidly changing guidelines.
