Identifying Built Environment Risk Factors to Provider Workflow and Patient Safety Using Simulation-Based Evaluation...

Area of Science:

• Healthcare facility design
• Patient safety engineering
• Clinical workflow analysis

Background:

• The built environment in healthcare facilities significantly impacts workflow and can lead to clinical errors and patient harm.
• Facility design presents an opportunity to proactively identify and mitigate safety risks associated with flow disruptions (FD).
• Simulation-based evaluations of proposed designs can identify and address safety concerns before construction and occupancy.

Purpose of the Study:

• To identify latent conditions and flow disruptions (FD) within a pediatric intensive care unit (PICU) setting.
• To analyze the characteristics of FD during simulated critical care scenarios.
• To inform the design process by identifying built environment features that cause FD.

Main Methods:

• Conducted simulations using physical mock-ups of a PICU room during a three-phased critical care scenario (admission/intubation, cardiac arrest, bedside surgery).
• Video recorded simulations from multiple angles.
• Systematically coded video recordings to identify and categorize flow disruptions (FD).

Main Results:

• Identified significant FDs in the respiratory therapist (RT) zone, nurse zone, and at the head of the patient.
• Challenges included spatial constraints, suboptimal equipment positioning, and impeded visibility due to monitor placement.
• Specific issues were noted in the RT zone and head of the bed (spatial constraints) and the nurse zone (equipment and visibility).

Conclusions:

• Simulation-based evaluation of patient care space prototypes is effective in identifying minor and major FDs.
• Findings related to the built environment provide valuable data for iterative design improvements.
• Proactive identification of FD through simulation can enhance patient safety in PICU environments.