P102: A quality improvement project: identifying and managing latent safety threats though a zone wide emergency department in-situ multidiscipline simulation program

Abstract

Introduction: High fidelity in-situ simulation has been found to detect system deficiencies, equipment failures, and conditions predisposing to medical errors, also known as latent safety threats (LST). What is not well reported is whether these LSTs are effectively managed. As a part of an ongoing quality improvement project, multidisciplinary, in-situ simulations were conducted across emergency departments (ED) in the Edmonton zone with the aim to identify LST and subsequently manage them to improve patient care. Methods: In 2017 simulations were conducted at EDs in the Edmonton Zone (N = 10). Following each simulation, a cross sectional, survey based assessment tool, was completed by participants to identify LST. These LST were shared with the site clinical nurse educator and/or site manager and a management plan made. Two to six months follow-up was made to track progress. For reporting, LST were grouped into themes, progress on LST were coded as either resolved, ongoing, or not managed. Results: A total of 112 LST were identified through 18 separate simulations. The most commonly identified LTS were: resuscitation resource required (n 23), lack of staff training (21), equipment not immediately available (20), IT resource required (8), medication not immediately available (6), staff requiring familiarization (5), medication resource required (5), IT issue (4), large equipment needed (4), small equipment needed (4), lack of staff resource (3), medication needed, (3), equipment malfunction (2), Environment cluttered (2), non-appropriate resource removed (2). Site follow-up identified a total of 52 LST that where resolved, and 60 LST that had ongoing work to manage them. No occurrences of LST not being managed were identified. Conclusion: Simulation was used to effectively identify LST. Creating a structured plan and follow up allowed many LST to be resolved and effectively managed. In 2018 simulation will reassess if LST remain. Keywords: quality improvement and patient safety, simulation, latent threats Introduction: The ECG diagnosis of acute coronary occlusion (ACO) in the setting of ventricular paced rhythm (VPR) is purported to be impossible. However, VPR has a similar ECG morphology to LBBB. The validated Smith-modified Sgarbossa criteria (MSC) have high sensitivity (Sens) and specificity (Spec) for ACO in LBBB. MSC consist of 1 of the following in 1 lead: concordant ST Elevation (STE) 1 mm, concordant ST depression 1 mm in V1-V3, or ST/S ratio < − 0.25 (in leads with 1 mm STE). We hypothesized that the MSC will have higher Sens for diagnosis of ACO in VPR when compared to the original Sgarbossa criteria. We report preliminary findings of the Paced Electrocardiogram Requiring Fast Emergency Coronary Therapy (PERFECT) study Methods: The PERFECT study is a retrospective, multicenter, international investigation of ED patients from 1/2008 -12/ 2016 with VPR on the ECG and symptoms suggestive of acute coronary syndrome (e.g. chest pain or shortness of breath). Data from four sites are presented. Acute myocar...