Use of Simulation in the Activation of New Clinical Spaces as a Proactive Risk Assessment and Hazard Mitigation Tool

Background: Clinical facilities within the Department of Defense are being activated as new construction and replacement facilities. Currently, Navy Medicine has three hospital systems under construction or near completion with U.S. Naval Hospital Okinawa scheduled to open in 2013 and U.S. Naval Hospital Guam and Camp Pendleton Naval Hospital scheduled to open in 2014.

With the opening of any new clinical facility come new operational realities and the potential for unforeseen hazards. These may be associated with the introduction of new processes, equipment, staffing, design layout and the available resources. Often we discover these risks too late, resulting in a possible near miss event or actual harm to our patients. Early identification of such risks, through structured simulation scenario design can prevent delays in facility activation, thus enhancing readiness and preventing construction or modification cost overruns.

Innovation: Given the increasing complexity of medical care and the interprofessional nature of healthcare, the ability to use high fidelity simulation in the activation of new clinical spaces to proactively identify and mitigate hazards prior to placing patients at risk would serve as the ideal risk assessment tool. Working with a collaborative interprofessional healthcare team, identification of existing hazards and lessons learned from other sites are pulled together to create a foundation for review. This group then works together to anticipate what could go wrong through brainstorming concerns related to patient care activities, staffing, environment of care and equipment. This brainstorming activity allows you to build simulation scenarios related to patient care and environment of care situations. The next step is the critical component in the activation process. By simulating the process, you allow direct care staff to uncover defects and hazards throughout the care process while identifying system wide and patient care related adverse events through in situ simulation. For example, during a mock code blue drill, our direct care staff identified that the new beds purchased for a long term care facility did not have removable head or foot boards to be utilized as a backboard for compressions. This allowed us an opportunity to mitigate the risk by purchasing a backboard to be maintained at the nurses’ station in the event of a code blue prior to nursing home residents moving in. Utilization of a hazard identification and mitigation worksheet while conducting in situ simulations allows participants to classify hazards and assign severity categories and probability levels to determine acceptability of risk and prioritize remedies. Finally, using the collected data, we can design a system that uses a multidisciplinary approach to ensure safety and monitor for patient safety events.

Potential Results: Clinical simulation-based events allow healthcare providers to bridge the gap between learning and performing, thus enhancing facility readiness, improving patient safety, and optimizing clinical outcomes. “Walking a day in the life of a patient” through simulation transfers the patient experience to facility designers and hospital staff and helps them validate design goals. The ability to simulate critical events (e.g., telemetry monitoring, bar code administration of medications on the inpatient ward) before hospital activation allows healthcare teams to more confidently, efficiently and effectively transition to new clinical spaces. The pre-opening identification and mitigation of potential hazards through simulation can translate into significant cost-savings and/or cost avoidance to military medicine, positively influencing the quadruple aim components of readiness, per capita cost and patient experience of care. In addition, the ability to tie simulation-aided risk analysis back to facility performance outcomes following activation of new clinical spaces will help solidify Department of Defense/BUMED’s role as an Industry Leader in Patient Safety and Healthcare Simulation.

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