(75) Integrating Simulation-based Clinical Systems Testing with Simulation-based Training to Improve Outcomes in the Sedation Services Post Anesthesia Care Unit

Abstract:

Introduction: The implementation of new high-risk workflows within complex units requires meticulous planning. However, work as imagined often deviates from work as done due to unforeseen barriers at the microsystem level. Using simulation to proactively test workflows can aid in identifying process improvement opportunities.

Methods: Using the Translational Work Integrating Simulation and Systems Testing (TWISST) framework, a process improvement tool, two unique multidisciplinary scenarios evaluated the new emergency response processes in the IR and MRI PACU. In-situ simulations assessed availability of supplies and equipment, team dynamics, and policies and procedures that may be impacted during the evaluation. Each simulation concluded in debriefing with the Sedation Services team and organizational leaders to identify and prioritize process improvement opportunities using a Failure Modes and Effects Analysis scoring tool. Findings were then used to create a Rapid Cycle Deliberate Practice (RCDP) Simulation to hardwire critical nursing skills.

Results: SbCST uncovered 47 total latent safety threats (LSTs). LSTs related to patient safety (n=36, 77%), equipment, supplies and technology (n=9, 19%), and policies and procedures (n= 2, 4%). Ten LSTs were present in both the IR and MRI emergency response processes. 28% (n=13) of LSTs were assigned a very high- or high-risk priority number. Subsequent Simulation-based Training addressed 38% of LSTs. RCDP education focused on knowledge gaps including airway management, emergency airway equipment usability, emergency medication administration, CPR ergonomics, and team dynamics.

Conclusion: Simulation-based Clinical Systems Testing coupled with Simulation-based Training optimized workflows and ultimately improved patient safety and clinical outcomes in the PACU.

Please include a short summary of your presentation that highlights why an attendee would want to view your poster.: High-risk, high-stakes processes and procedures are inherent within the complex dynamics of the healthcare industry. Focusing simulation education solely on individual knowledge gaps can fail to address deeper rooted latent safety threats within the system. An opportunity exists to pair Simulation-based Clinical Systems testing with targeted simulation-based training to simultaneously optimize workflows and improve patient safety and clinical outcomes.