Simulation-Based Clinical Systems Testing Before Opening a Pediatric Critical Care Building.

Area of Science:

• Healthcare Safety
• Clinical Systems Engineering
• Pediatric Critical Care

Background:

• Opening a new large critical care building (CCB) presents significant patient safety challenges.
• Proactive identification and mitigation of latent safety threats (LSTs) are crucial before clinical operations commence.

Purpose of the Study:

• To implement and evaluate simulation-based clinical systems testing (SbCST) for identifying LSTs in a new pediatric CCB.
• To assess the effectiveness of SbCST in a large-scale healthcare setting prior to patient admission.

Main Methods:

• Conducted SbCST involving 20 care units/groups with in situ simulations over 9 weeks.
• Utilized a modified Promoting Excellence And Reflective Learning (PEARLS) format for debriefing and LST documentation.
• Employed failure modes and effect analysis (FMEA) for scoring LSTs and developing mitigation strategies.

Main Results:

• Completed 128 of 141 (91%) scheduled simulation sessions, generating 238 scenarios.
• Identified 1500 LSTs, with a median of 10 per scenario.
• Assigned FMEA scores to 97% of LSTs, with 76% indicating low risk; mitigations were suggested for 63%.

Conclusions:

• SbCST is an effective method for identifying LSTs, even at the scale of a large critical care building.
• FMEA scoring and a mitigation categorization schema improved the SbCST process.
• This approach can enhance the safety of comparable clinical spaces, despite potential limitations in generalizability due to scale.