Simulation-based clinical systems testing for healthcare spaces: from intake through implementation

Abstract

Healthcare systems are urged to build facilities that support safe and efficient delivery of care. Literature demonstrates that the built environment impacts patient safety. Design decisions made early in the planning process may introduce flaws into the system, known as latent safety threats (LSTs). Simulation-based clinical systems testing (SbCST) has successfully been incorporated in the post-construction evaluation process in order to identify LSTs prior to patient exposure and promote preparedness, easing the transition into newly built facilities. As the application of simulation in healthcare extends into the realm of process and systems testing, there is a need for a standardized approach by which to conduct SbCST in order to effectively evaluate newly built healthcare facilities. This paper describes a systemic approach by which to conduct SbCST and provides documentation and evaluation tools in order to develop, implement, and evaluate a newly built environment to identify LSTs and system inefficiencies prior to patient exposure. Electronic supplementary material The online version of this article (10.1186/s41077-019-0108-7) contains supplementary material, which is available to authorized users.

SAFEE: A Debriefing Tool to Identify Latent Conditions in Simulation-based Hospital Design Testing

“…In SbCST, care processes are fully implemented in order to identify flaws in all elements of the work system [3,19]. Educational opportunities are identified (people), staffing models are adjusted (organization), and technologies are modified (technology) [3] to improve quality of care and safety (outcomes) [1,11,14].…”

“…In the early phase of hospital design planning, the ability to mitigate risk is imperative as design decisions can lead to unintended downstream effects that may lead to patient harm [4]. Simulation-based Clinical Systems Testing (SbCST) has been applied in the evaluation of built and occupied healthcare environments to identify system gaps and safety threats with the goal to mitigate risk and improve outcomes [5][6][7][8][9][10][11]. However, once open for patient care, major architectural remodeling or retrofitting of healthcare facilities to mitigate risk related to the built environment is impractical and cost prohibitive [12].…”

“…The goal of SbCST, defined as an in situ simulation-based strategy employed in functioning healthcare spaces, is to identify gaps in the work system and processes, ensure operational readiness, and ease transitioning by promoting preparedness [ 5 – 7 , 11 , 18 ]. In SbCST, care processes are fully implemented in order to identify flaws in all elements of the work system [ 3 , 19 ].…”

Translational simulation: from description to action

“…Team Emergency Assessment Measure (TEAM) [ 38 ] Time-to-event, e.g. time to CT scan for trauma patients [ 8 ] Safe design goals observer tool [ 39 ] Ethnographic observation [ 6 ] Monitoring Video and/or audio recording and streaming Motion tracking [ 5 ] Eye movement tracking [ 40 ] Other ergonomic assessment tools (e.g. heart rate monitoring, strain measurements) [ 41 ] Learning conversations Debrief approaches Rapid cycle deliberate practice [ 42 ] (can be modified to improve processes as well as individual performance) Systems-focused Promoting Excellence and Reflective Learning in Simulation (PEARLS) framework [ 43 ] SAFEE debriefing tool [ 44 ] (based on evidence-based design principles) Pluralist walkthrough [ 41 ] with iterative discussions ‘Brainstorm’ sessions [ 45 , 46 ] (e.g.…”

Rapidly building surge capacity within a pandemic response using simulation-based clinical systems testing

“…Simulation-based clinical systems testing (SbCST) has been previously described to identify latent safety threats (LSTs) prior to opening new healthcare facilities, typically with months of simulation planning prior to implementation, and additional time to remediate potential safety issues prior to opening. 5 6 However, there are no published descriptions of the rapid use of SbCST to develop and improve processes for pandemics and temporary units, which by necessity operate on a much shorter timeline, in this case also with additional requirements for physical distancing. We describe the use of both tabletop simulation and SbCST using video conferencing technology to rapidly test MPERT processes for a pandemic response across three hospital campuses.…”