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Financial and Safety Impact of Simulation-based Clinical Systems Testing on Pediatric Trauma Center Transitions
Sacha A Williams1, Katie Fitzpatrick2, Nicole M Chandler1
1Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Fla.
Pediatric Quality & Safety
|August 29, 2022
Summary
Simulation-based clinical systems testing (SbCST) effectively managed pediatric trauma center changes, identifying safety risks and providing financial benefits. This approach improved patient safety and reduced costs associated with adverse events.
Area of Science:
- Medical Simulation
- Healthcare Systems Engineering
- Patient Safety
Background:
- Little is known about applying simulation to pediatric trauma workflow changes.
- Institutions face risks during significant clinical process changes, such as establishing an independent pediatric trauma center.
Purpose of the Study:
- To describe the simulation-based clinical systems testing (SbCST) process.
- To evaluate the impact of SbCST on patient safety during clinical changes.
- To estimate the financial costs and benefits of implementing SbCST.
Main Methods:
- Stakeholders developed simulation scenarios based on change-related needs.
- Implemented simulation scenarios and conducted postsimulation failure mode and effects analysis (FMEA) to identify latent safety threats (LSTs).
- Prioritized and mitigated LSTs based on risk, calculating costs and estimating savings through adverse event avoidance, reduced readmissions, and avoided lawsuits.
Main Results:
- Two simulation scenarios were implemented pre-change, revealing 49 LSTs, with 9 identified as highest priority.
- Mitigation of high-priority LSTs was performed using the hospital's quality/safety framework.
- Cost-benefit analysis indicated net savings of $52,000–$227,000 over three months, with favorable outcomes from readmission and liability estimates.
Conclusions:
- The SbCST approach successfully identified high-impact safety risks in pediatric trauma workflow changes.
- SbCST provided significant financial benefits to the institution during this transition.
- This methodology offers a valuable tool for managing risks associated with clinical process changes in healthcare settings.
