The large-scale relocation of a paediatric hospital is a significant undertaking. New environments change the system, and ways of working must adapt to maintain quality healthcare. There are risks to patients and staff well-being, with high anxiety around change. There is evidence for the efficacy of simulation as a tool for safe training and rehearsal of staff and teams [1] but less so on such a large scale. Simulation for many is still perceived as a test of performance and a threat. We connected with the international simulation community to design a hospital-wide programme of Patient Environment Simulations for Systems Integration (PESSI). This paper outlines challenges in establishing buy-in from stakeholders and departments, developing a framework for implementation and our reflections on delivery of large-scale simulation activities to assist a hospital move.How can simulation-based methodology be used to support clinical departments on a large scale to adapt/integrate/prepare in moving to a brand-new hospital?Collaboration with authors of PEARLS for system integration use [1], using it as the main framework for delivery and structure of PESSI. Stages of delivery were: pre-phase work, system testing day, debrief/reflection and evaluation. Immediate feedback of enjoyment and learning was collated from all participants. Three-month post-move feedback is planned to review ongoing impact/behaviour change plus analysis of safety incidents.Pre-phase work involved meeting stakeholders and establishing aims of testing. Ward managers were key departmental links, meeting with members of PESSI to plan scenarios. System testing days involved familiarizing themselves with the environment, followed by ‘day in the life’ simulations with a representation of the whole team. All participants were called ‘co-faculty’ and knew exactly what would happen. Debrief involved facilitated conversations with the whole team describing reactions, and deeper analysis of the key events, with concerted efforts by facilitators to give a balanced approach of positives and challenges. A short report was given back to the department detailing the findings teams would need solutions to. Solutions from simulation were implemented prior to the move, increasing staff confidence, with many feeling PESSI played a major role in feeling prepared for the new site. The PESSI framework is being utilized in adult services and we hope to publish our methodology to share with the wider simulation community.
regulating the pace of discussion (76.6%), encouraged students to feedback about how the class is run (90%) and would be useful for both online TBLs (86.6%) and in-person TBLs (83.3%). Instructors felt that the tool helped their decision making in respect of providing a simple yet effective way of gathering information about student understanding and hence knowing whether to dwell further on a discussion point or not. | WHAT LESSONS WERE LEARNED?We found that real-time student feedback provided via a simple online tool allowed instructors to quickly make informed and justified choices about whether to have further discussion or move on. The psychology of learning suggests that student and instructor engagement is symbiotic: If instructors are not responsive to feedback, then students will stop giving feedback and disengage. Instructors were responsive to the feedback delivered via our tool, then students were rewarded for giving feedback (with more tailored discussion and instruction), which then encouraged them to initiate further feedback, leading to a virtuous feedback loop. In this way, learner-to-instructor engagement resulted in higher student engagement. 1
ContextWe undertook this improvement project in the Acute Receiving Unit (ARU) of the Royal Hospital for Sick Children in Edinburgh.ProblemThere is a fast turnover of patients on ARU. Patients are often discharged prior to all their investigation results being available. Outstanding results must be reviewed in a timely fashion to ensure appropriate action is taken. This is critical to patient management.Assessment of problem and analysis of its causeIn 2011 an audit of time to review results showed considerable delays. The median time was 13 days, interquartile range 8–19 days. This was unacceptable, and incurred considerable risks.The main reas was thought to be the use of a handwritten diary to remind junior doctors to chase results. Other contributing factors included high workload and rapid patient turnover.InterventionAn electronic ‘workbench’ was set up to display ‘unread’ results in an alphabetical list according to patient surname. Hosted on the same system as patients’ electronic records facilitating easy review of clinical and contact details of patients and GPs, and documentation of action.A guideline was written to outline how to set up the workbench. Allocation of a doctor to review the workbench on a daily basis was advised.Study designWe conducted a second audit in 2015. We assessed the time taken to review results, appropriateness and documentation of action taken.Strategy for changeWe presented our findings locally to the medical team. The guideline was disseminated, and discussed during the ARU induction to all rotating junior doctors.Measurement of improvementThe re-audit showed considerable improvement in time to review, with median time 6 days, interquartile range 2–9 days. Unfortunately documentation of action was deemed appropriate in only a third.An unintended effect of the electronic workbench is the inclusion of inappropriate results. Nearly a third of results reviewed were incorrectly displayed on the ARU workbench. This results in an increased workload, and takes precious time to resolve. Reasons for this include patients being incorrectly allocated to a consultant, and doctors ordering tests against previous ARU episodes incorrectly.Effects of changeInstitution of an electronic workbench resulted in a considerable improvement. A median of 6 days is still longer than our proposed standard of 72 h. The unintended increase in workload is a significant barrier to efficiency. (See image)We have instituted additional education and guidance to address the different contributing factors. These include clear display of the admitting consultant rota in all clinical areas to ensure correct consultant allocation. Education of nursing, medical and administrative staff has also been conducted.Guidance has been disseminated to medical staff, and displayed in the ward doctors’ office. Progress on the workbench is discussed at our lunchtime meeting to ensure adequate resource allocation. The IT team has been involved to improve the electronic system.Abstract G536 Figure 1Lessons learntThere are often m...
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