Video-Recorded In Situ Simulation Before Moving to the New Combined Neonatal/Pediatric Intensive Care Facility: An Observational Study

Abstract

Moving an ICU to a new location is a challenge. The objective of this study was to use in situ simulation to identify potential problems and solutions with the new environment before commencing patient care.DESIGN: Planned, observational video-recorded simulation study using four scenarios: delivery room management of term-neonate; delivery room management of extremely low-birth-weight infant; management and transfer of an infant with respiratory syncytial virus bronchiolitis and apnea; and management and transfer of an adolescent with septic shock. SETTING: Academic tertiary neonatal and combined neonatal ICU/PICU. PARTICIPANTS: Sixteen volunteers (eight physicians, eight nurses). INTERVENTIONS:Standardized briefing introduction, with before versus after survey of thoughts about each scenario, and after 8 weeks, debriefing at least 60 minutes and additional video recording. MEASUREMENTS AND MAIN RESULTS:A total of 91 potential problem areas were identified and included issues related to technical aspects (n = 29), infrastructure (n = 27), administration (n = 19), and structure (n = 16). Fifty-three (58%) of these potential issues could be resolved before the move, including: 15 of 29 technical, 15 of 27 infrastructure, nine of 19 administration, and 14 of 16 structural. The video analysis revealed an additional 13 problem areas (six technical, three infrastructure, two administration, and two structural). Participants felt more confident 8 weeks after the simulations (χ 2 = 12.125; p < 0.002). All 16 participants confirmed the usefulness of the in situ simulation, the majority wanted further introductions to the new ward (n = 13) and noted a positive impact of the changes on the new ward (n = 12). CONCLUSIONS:In situ simulation before moving into a new facility identifies numerousness potential problem areas. Survey shows that providers feel better prepared and are more confident. Video recording reveals additional difficulties not addressed in conventional verbal debriefing. KEY WORDS: improvement; in situ simulation; new facility; quality of care; video recording M oving a combined neonatal ICU/PICU to a new location, with twice the capacity, is a challenge for the staff. Despite precise planning, deficits and possible options for improvement only become apparent when the new ward is put into operation. This is accompanied by a considerable safety risk for patients (1, 2). When establishing or restructuring a new ward, it is essential to achieve full functionality by optimizing infrastructure and work processes (1, 3).

Evaluating the safety and quality of portable x-ray imaging in a new infectious disease biocontainment unit: an in situ simulation and video-reflexive study

“…Video is critical to engendering re exivity. In our study, as found by Krammer et al (9), analysis of the video footage not only con rmed problems anticipated by radiographers prior to, and during the simulation, it also shed light on many additional issues. This is because video connects people to their ways of working in new ways, allowing them to see things in a different light (24).…”

“…These included, increased risks of exposure to infection, occupational injury and radiation, and interference with communication and X-ray quality. As with other studies, by conducting this investigation prior to the rooms being commissioned, it was possible to minimise the risks of endangering staff and patients (1,9). While some of the issues were identi ed prior to, or during, the in situ simulation, several unforeseen but important issues, across all four areas of risk, were identi ed and articulated only during reviews of video footage.…”

“…Furthermore, design aws and solutions relevant to one setting may not be applicable or appropriate in others (7). Even with meticulous planning, latent safety threats (8) can be present in new designs, and areas for improvement may be only apparent once a new space is operationalised (1,9).…”

“…A literature search for in situ simulation studies, designed to evaluate operational readiness of new or refurbished healthcare facilities, produced only a few studies that included video footage in their data collection. In several of these studies, video analysis for latent safety threats took place after the simulation and debrief, and was conducted by researchers, rather than participants themselves (9,13,15). A study by Geis et al (16) used video debrie ng with participants, but the authors suggested that their study could have been strengthened by involving participants in more in-depth video debrief and analysis.…”

Exploring the safety and quality of mobile X-ray imaging in a new infectious disease biocontainment unit: an in situ simulation and video-reflexive study

“…In several of these studies, video analysis for latent safety threats took place after the simulation and debrief, and was conducted by researchers, rather than participants themselves. 9 13 15 A study by Geis et al 16 used video debriefing with participants, but the authors suggested that their study could have been strengthened by involving participants in more in-depth video debrief and analysis. Bender et al 14 mainly used verbal debrief to identify issues, but used video to highlight or clarify particular events.…”