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

We used simulation-based clinical systems testing (SbCST) to identify and mitigate latent safety threats (LSTs) before opening a large critical care building (CCB) at a pediatric institution.

We completed an SbCST project to identify LSTs before opening a 7-floor, 319-bed CCB at a pediatric institution. The extensive preparation process included warehouse planning sessions and a formal intake process. A total of 20 care units/groups had at least one 3-hour in situ simulation session. Each simulation scenario lasted approximately 1 hour (20-minute simulation, 40-minute debriefing). Participants included clinical teams and unit stakeholders. Facilitators received SbCST training, led debriefing using a modified Promoting Excellence And Reflective Learning (PEARLS) format, and documented LSTs along with suggested mitigations. Unit/group stakeholders scored LSTs using failure modes and effect analysis (FMEA) and were responsible for completing mitigations.

We completed 128 of 141 (91%) scheduled sessions over a 9-week period. Across all sessions, 238 scenarios were completed. The mean number of scenarios was 2 per session and 12 per unit/care group. We identified 1500 LSTs; the median per scenario was 10 (IQR 7-15, range 0-54). FMEA scores were assigned to 1450 (97%) LSTs. Median FMEA was 8 (IQR 4-16); 76% of scores were low (<16). Mitigations were suggested for 951 (63%) of LSTs.

Even at scale, SbCST is an effective tool for identifying LSTs. FMEA scoring and a categorization schema for mitigations enhanced SbCST. Although the scale of this project has limited generalizability, any application of this approach would likely enhance the safety of comparable clinical spaces.