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Outcomes from In Situ Simulation Testing Before Opening a New Hospital for Women and Newborns

Objectives:

A series of in situ simulations involving high-risk obstetric emergencies were analyzed to identify potential latent threats to patient safety prior to opening of Texas Children’s Hospital Pavilion for Women in March 2012.

Study Design:

Twelve high-fidelity simulation-based testing scenarios were completed to include high-risk patient care areas and obstetrical clinical scenarios. The 97 participants tested in multi-disciplinary teams included practicing clinicians, residents, and nurses/staff from our obstetric, neonatology, and anesthesia teams. Extensive debriefing after each scenario were done to complete our analysis.

Results:

Seventy-one broad clinical systems issues were identified in terms of resource and systems issues, facility/space design concerns, and clinical performance gaps. Eleven of those were associated with clinical performance deficiencies in cognitive, technical, and communication skills. Two clear examples of performance gaps identified from our study that could be used for future simulation-based training were lack of knowledge and experience with specific clinical situations (i.e. postpartum hemorrhage/mass transfusion protocol and eclamptic seizure) and ineffective communication between different healthcare teams.

Conclusions:

The analysis of simulation-based testing identified potential latent safety threats, and determined clinical performance gaps that could be the focus of future multidisciplinary simulation-based training. The incorporation of future simulation-based training will then allow the clinical teams to rehearse infrequent and/or high-risk clinical scenarios and be more comfortable with new processes for patient care.

Topics: 2013, Faculty, Patient Care, GME, Simulation, Quality & Safety,