MACROSYSTEM SIMULATIONS IN A NEW HOSPITAL FACILITY
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printed by www.postersession.com Opening of a new hospital unit presents an opportunity to vet systems, workflows and personnel using large-system simulations prior to introduction of patients to new environments. We used macrosystem simulation in surgical units of a newly constructed hospital to assess system operations, training, and latent safety threats on a timeline to enable corrections if needed. Sixty-three pre- and post-surveys were received. 52% were from direct healthcare providers who had “hands-on” the simulated patients. Self- reported preparedness to work on the new units improved significantly following simulation. Respondent details (Table 1) and survey results (Table 2 and Figure 5) are summarized below. Areas reviewed using Student’s t - test included Physical Orientation 3.93±0.96SD vs 4.47±0.63SD (p=0.011), Technology 3.50±1.00SD vs 3.98±0.78SD (p=0.049), Resource Availability 3.38±0.86SD vs 4.12±0.59SD (p<0.001), Non-emergent Situations 3.93±1.00SD vs 4.38±0.65SD (p=0.035), Emergent Situations 3.84±0.87SD vs 4.31±0.65SD (p=0.027), Defined Role 3.46±0.84SD vs 4.30±0.66SD (p<0.001) and Institutional Preparation 3.41±1.05SD vs 4.38±0.60SD (p<0.001). Twenty- eight potential safety threats were grouped into overarching themes: 1) Equipment, 2) Technology, 3) Wayfinding, 4) System-Based Guidelines, 5) Physical Structure and 6) Education. Two macrosystem simulations were conducted on separate units of a new facility serving surgery patients. Participants consisted of nurses, physicians, respiratory therapists, chaplains, advanced practitioners, and administrative, environmental services and security personnel. Simulations incorporated high-fidelity patient simulators and patient actors in either high-acuity multi-trauma (Figure 1. Trauma SW-7 Simulation) or complex post-surgical situations (Figure 2. Thoracic SW-5 Simulation) requiring multi-service participation. Scenarios required transport to and from various locations within the hospital, such as the Emergency Department, Post-Anesthesia Care Unit, X-ray suite, and Family Waiting Room. The simulations necessitated activation of emergency systems: cardiopulmonary arrest, fire, and combative patient/assault. In addition to activating emergency systems, the scenarios also activated the following hospital services: environmental services, spiritual services and volunteer services. Response times for emergency systems and other services were recorded. Pre- and post-simulation surveys (Figures 3 and 4, respectively) assessed participants’ preparedness in defined areas (1-5 Likert scale, comparisons by t-test). Post-event debriefings addressed preparedness factors in place and focused on system, workflow, and safety issues that might require correction. Macrosystem simulation for assessment of preparedness and safety in new hospital units is largely untested. Our experience suggested that personnel exposed to such simulations gain knowledge and confidence, and the process is able to identify potential system improvements. We propose further use of macrosystem simulation to investigate best practices to maximize institutional readiness in newly opened environments. INTRODUCTION METHODS RESULTS CONCLUSIONS MACROSYSTEM SIMULATIONS IN A NEW HOSPITAL FACILITY Gladys L. Fernandez MD, John J. Budrow BS, Neal E. Seymour MD FACS Baystate Medical Center, Baystate Simulation Center, University of Massachusetts Medical School-Baystate Health, Springfield, MA Fig 1. Trauma SW-7 Simulation Fig 2. Thoracic SW-5 Simulation Macrosimulation HOF South 5 - 7 Systems Preparedness Survey: POST- Simulation Date: ____________ Job title/role: RN PCT MD PA/NP IV team (please circle) Respiratory Ther RRT member Radiology Tech Security Lift Team Engineering Svc Facilities member Environmental Svc Pharmacy Fire Dept Volunteer Svc Interpreter Svc Spiritual Svc Other: _______________ Apart from today, have you participated in whole unit based simulation in the past? (please circle) No Yes (If “Yes” , please explain) ___ ______________________________ For the following questions, please circle the most approp riate response on a 1-5 scale detailed as: 1 2 3 4 5 Extremely Low Low Neutral High Extremely High 1. How would you rate your comfort level with physical orientation (finding your way) to the new unit after today’s simulation ? 1 2 3 4 5 2. A. Did you use any new technology (e.g. bedside monitors, nursing station monitors, secure site access, badge access, vocera communications, alarm systems) in the new unit during today’s simulation? (please circle) No Yes (If “No” , pl ease skip 2B. If “Yes” please, proceed to 2B ) B. How would you rate your comfort level with use of new technology (e.g. bedside monitors, nursing station monitors, secure site access, badge access, vocera communications, alarm systems) in the new unit after today’s simulation ? 1 2 3 4 5 3. A. Did you use any resources (e.g. patient care supplies, communication systems, monitoring systems, radiology access, emergency carts/supplies) in the new unit during today’s simulation? (please circle) No Yes (If “No”, please skip 3B. If “Yes” please, proceed to 3B) B. How would you rate your comfort level with resource availability (e.g. patient care supplies, communication systems, monitoring systems, radiology access, emer gency carts/supplies) in the new unit after today’s simulation ? 1 2 3 4 5 4. How would you rate your comfort level participating in a non - emergent care situation in your area of expertise in the new unit after today’s simulation ? 1 2 3 4 5 5. How w ould you rate your comfort level participating in an emergent/critical care situation in your area of expertise in the new unit after today’s simulation ? 1 2 3 4 5 6. How would you rate your confidence level working in this new unit in your defined role AF TER simulation ? 1 2 3 4 5 7. How would you rate your confidence level with the institution’s work to prepare you for the move into the new unit AFTER simulation? 1 2 3 4 5 8. What did you gain from today’s simulation? 9. Comments: Thank you for your time and participation. Macrosimulation HOF South 5 - 7 Systems Preparedness Survey: PRE- Simulation Date: ____________ Job title/role: RN PCT MD PA/NP IV team (please circle) Respiratory Ther RRT member Radiology Tech Security Lift Team Engineering Svc Facilities me mber Environmental Svc Pharmacy Fire Dept Volunteer Svc Interpreter Svc Spiritual Svc Other: _ _ _____ ____ ___ Have you participated in whole unit based simulation in the past? (please circle) No Yes (If “Y es ” , please e xplain) _ ____ ______________________ For the following questions, please circle the most appropriate response on a 1 - 5 scale detailed as: 1 2 3 4 5 Extremely Low Low Neutral High Extremely High 1. How would you rate your comfort level with physic al orientation ( finding your way ) to the new unit ? 1 2 3 4 5 2. How would you rate your comfort level with use of new technology (e.g. bedside monitors, nursing station monitors, secure site access, badge access, vocera communications, alarm systems) in t he new unit ? 1 2 3 4 5 3. How would you rate your comfort level with resource availability (e.g. patient care supplies, communication systems, monitoring systems, radiology access, emergency carts/supplies) in t he new unit ? 1 2 3 4 5 4. How would you rate your comfort level participating in a non - emergent care situation in your area of expertise in t he new unit ? 1 2 3 4 5 5. How would you rate your comfort level participating in an emergent/critical care situation in your area of expertise in t he new unit ? 1 2 3 4 5 6. How would you rate your confidence level working in this new unit in your defined role BEFORE simulation? 1 2 3 4 5 7. How would you rate your confiden ce level with the institution’s work to prepare you for the move into the new unit BEFORE simulati on? 1 2 3 4 5 8. What do you expect to gain from today’s simulation? 9. Comments: Thank you for your time and participation. Fig 3. Pre-simulation survey Fig 4. Post-simulation survey Title/ Role Number of Responses % of total Healthcare Providers 33 52% Other* 12 19% Respiratory Therapist 5 8% Patient Care Technician 5 8% Spiritual Services 4 6% Rapid Response Team 2 3% Facilities 1 2% Security 1 2% Total 63 100% *Lift team, Volunteer services, Hospital Administration, Engineering, Environmental New Facility Personnel/Responders Table 1. Macrosimulation Responders New Unit Areas of Preparedness Pre- simulation survey responses (N=29) Post- simulation survey responses (N=34) p value [Wayfinding] How would you rate your comfort level with physical orientation (finding your way) to the new unit? 3.93±0.96SD 4.47±0.63SD 0.011 [Technology] How would you rate your comfort level with use of new technology (e.g. bedside monitors, nursing station monitors, secure site access, badge access, vocera communications, alarm systems) in the new unit? 3.50±1.00SD 3.98±0.78SD 0.049 [Resources] How would you rate your comfort level with resource availability (e.g. patient care supplies, communication systems, monitoring systems, radiology access, emergency carts/ supplies) in the new unit? 3.38±0.86SD 4.12±0.59SD < 0.001 [Non-emergency preparedness] How would you rate your comfort level participating in a non- emergent care situation in your area of expertise in the new unit? 3.93±1.00SD 4.38±0.65SD 0.035 [Emergency preparedness] How would you rate your comfort level participating in an emergent/critical care situation in your area of expertise in the new unit? 3.84±0.87SD 4.31±0.65SD 0.027 [Training and role definition] How would you rate your confidence level working in this new unit in your defined role before simulation? 3.46±0.84SD 4.30±0.66SD <0.001 [Institutional preparation] How would you rate your confidence level with the institution's work to prepare you for the move into the new unit before simulation? 3.41±1.05SD 4.38±0.60SD <0.001 NEW UNIT PRE- AND POST-SIMULATION SURVEY RESULTS Table 2. Pre- and Post-Simulation Survey Results Fig 5. Pre- and Post-Simulation Comparison Chart
Transcript of MACROSYSTEM SIMULATIONS IN A NEW HOSPITAL FACILITY
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Opening of a new hospital unit presents an opportunity to vet
systems, workflows and personnel using large-system simulations
prior to introduction of patients to new environments. We used
macrosystem simulation in surgical units of a newly constructed
hospital to assess system operations, training, and latent safety
threats on a timeline to enable corrections if needed.
Sixty-three pre- and post-surveys were received. 52% were from direct
healthcare providers who had “hands-on” the simulated patients. Self-
reported preparedness to work on the new units improved significantly
following simulation. Respondent details (Table 1) and survey results (Table
2 and Figure 5) are summarized below. Areas reviewed using Student’s t-
test included Physical Orientation 3.93±0.96SD vs 4.47±0.63SD (p=0.011),
Technology 3.50±1.00SD vs 3.98±0.78SD (p=0.049), Resource Availability
3.38±0.86SD vs 4.12±0.59SD (p<0.001), Non-emergent Situations
3.93±1.00SD vs 4.38±0.65SD (p=0.035), Emergent Situations 3.84±0.87SD vs
4.31±0.65SD (p=0.027), Defined Role 3.46±0.84SD vs 4.30±0.66SD (p<0.001)
and Institutional Preparation 3.41±1.05SD vs 4.38±0.60SD (p<0.001). Twenty-
eight potential safety threats were grouped into overarching themes: 1)
Equipment, 2) Technology, 3) Wayfinding, 4) System-Based Guidelines, 5)
Physical Structure and 6) Education.
Two macrosystem simulations were conducted on separate units of a new facility serving
surgery patients. Participants consisted of nurses, physicians, respiratory therapists,
chaplains, advanced practitioners, and administrative, environmental services and security
personnel. Simulations incorporated high-fidelity patient simulators and patient actors in
either high-acuity multi-trauma (Figure 1. Trauma SW-7 Simulation) or complex post-surgical
situations (Figure 2. Thoracic SW-5 Simulation) requiring multi-service participation.
Scenarios required transport to and from various locations within the hospital, such as the
Emergency Department, Post-Anesthesia Care Unit, X-ray suite, and Family Waiting Room.
The simulations necessitated activation of emergency systems: cardiopulmonary arrest, fire,
and combative patient/assault. In addition to activating emergency systems, the scenarios
also activated the following hospital services: environmental services, spiritual services and
volunteer services. Response times for emergency systems and other services were recorded.
Pre- and post-simulation surveys (Figures 3 and 4, respectively) assessed participants’
preparedness in defined areas (1-5 Likert scale, comparisons by t-test). Post-event debriefings
addressed preparedness factors in place and focused on system, workflow, and safety issues
that might require correction.
Macrosystem simulation for assessment of preparedness and safety in new
hospital units is largely untested. Our experience suggested that personnel
exposed to such simulations gain knowledge and confidence, and the
process is able to identify potential system improvements. We propose
further use of macrosystem simulation to investigate best practices to
maximize institutional readiness in newly opened environments.
INTRODUCTION METHODS RESULTS
CONCLUSIONS
MACROSYSTEM SIMULATIONS IN A NEW HOSPITAL FACILITY Gladys L. Fernandez MD, John J. Budrow BS, Neal E. Seymour MD FACS
Baystate Medical Center, Baystate Simulation Center, University of Massachusetts Medical School-Baystate Health, Springfield, MA
Fig 1. Trauma SW-7 Simulation Fig 2. Thoracic SW-5 Simulation
Macrosimulation HOF South 5 - 7 Systems Preparedness Survey: POST- - Simulation Date: ____________
Job title/role: RN PCT MD PA/NP IV team (please circle) Respiratory Ther RRT member Radiology Tech Security Lift Team Engineering Svc Facilities member Environmental Svc Pharmacy Fire Dept Volunteer Svc Interpreter Svc Spiritual Svc Other: _______________ Apart from today, have you participated in whole unit based simulation in the past? (please circle) No Yes
(If “Yes” , please explain) ___ ______________________________
For the following questions, please circle the most approp riate response on a 1-5 scale detailed as: 1 2 3 4 5
Extremely Low
Low Neutral High Extremely High
1. How would you rate your comfort level with physical orientation (finding your way) to the new unit after today’s
simulation ?
1 2 3 4 5 2. A. Did you use any new technology (e.g. bedside monitors, nursing station monitors, secure site access, badge
access, vocera communications, alarm systems) in the new unit during today’s simulation? (please circle) No Yes (If “No” , pl ease skip 2B. If “Yes” please, proceed to 2B )
B. How would you rate your comfort level with use of new technology (e.g. bedside monitors, nursing station monitors, secure site access, badge access, vocera communications, alarm systems) in the new unit after today’s simulation ?
1 2 3 4 5 3. A. Did you use any resources (e.g. patient care supplies, communication systems, monitoring systems, radiology
access, emergency carts/supplies) in the new unit during today’s simulation? (please circle) No Yes (If “No”, please skip 3B. If “Yes” please, proceed to 3B)
B. How would you rate your comfort level with resource availability (e.g. patient care supplies, communication systems, monitoring systems, radiology access, emer gency carts/supplies) in the new unit after today’s simulation ?
1 2 3 4 5 4. How would you rate your comfort level participating in a non - emergent care situation in your area of expertise in
the new unit after today’s simulation ?
1 2 3 4 5 5. How w ould you rate your comfort level participating in an emergent/critical care situation in your area of expertise
in the new unit after today’s simulation ?
1 2 3 4 5 6. How would you rate your confidence level working in this new unit in your defined role AF TER simulation ?
1 2 3 4 5 7. How would you rate your confidence level with the institution’s work to prepare you for the move into the new
unit AFTER simulation?
1 2 3 4 5 8. What did you gain from today’s simulation? 9. Comments: Thank you for your time and participation.
Macrosimulation HOF South 5 - 7 Systems Preparedness Survey: PRE- - Simulation Date: ____________ Job title/role: RN PCT MD PA/NP IV team (please circle) Respiratory Ther RRT member Radiology Tech Security Lift Team
Engineering Svc Facilities me mber Environmental Svc Pharmacy Fire Dept Volunteer Svc Interpreter Svc Spiritual Svc Other: _ _ _____ ____ ___ Have you participated in whole unit based simulation in the past? (please circle) No Yes (If “Y es ” , please e xplain) _ ____ ______________________
For the following questions, please circle the most appropriate response on a 1 - - 5 scale detailed as: 1 2 3 4 5
Extremely Low
Low Neutral High Extremely High
1. How would you rate your comfort level with physic al orientation ( finding your way ) to the new unit ?
1 2 3 4 5
2. How would you rate your comfort level with use of new technology (e.g. bedside monitors, nursing station monitors, secure site access, badge access, vocera communications, alarm systems) in t he new unit ?
1 2 3 4 5
3. How would you rate your comfort level with resource availability (e.g. patient care supplies, communication systems, monitoring systems, radiology access, emergency carts/supplies) in t he new unit ?
1 2 3 4 5
4. How would you rate your comfort level participating in a non - emergent care situation in your area of expertise in t he new unit ?
1 2 3 4 5
5. How would you rate your comfort level participating in an emergent/critical care situation in your area of expertise in t he new unit ?
1 2 3 4 5
6. How would you rate your confidence level working in this new unit in your defined role BEFORE simulation?
1 2 3 4 5
7. How would you rate your confiden ce level with the institution’s work to prepare you for the move into the
new unit BEFORE simulati on?
1 2 3 4 5
8. What do you expect to gain from today’s simulation?
9. Comments:
Thank you for your time and participation.
Fig 3. Pre-simulation survey Fig 4. Post-simulation survey
Title/ Role
Number of Responses
% of total
Healthcare Providers 33 52% Other* 12 19% Respiratory Therapist 5 8% Patient Care Technician 5 8% Spiritual Services 4 6% Rapid Response Team 2 3% Facilities 1 2% Security 1 2% Total 63 100%
*Lift team, Volunteer services,
Hospital Administration,
Engineering, Environmental
New Facility Personnel/Responders
Table 1. Macrosimulation Responders
New Unit Areas of Preparedness
Pre-
simulation
survey
responses
(N=29)
Post-
simulation
survey
responses
(N=34)
p value
[Wayfinding] How would you rate your comfort
level with physical orientation (finding your way)
to the new unit? 3.93±0.96SD 4.47±0.63SD 0.011
[Technology] How would you rate your comfort
level with use of new technology (e.g. bedside
monitors, nursing station monitors, secure site
access, badge access, vocera communications,
alarm systems) in the new unit? 3.50±1.00SD 3.98±0.78SD 0.049
[Resources] How would you rate your comfort
level with resource availability (e.g. patient care
supplies, communication systems, monitoring
systems, radiology access, emergency carts/
supplies) in the new unit? 3.38±0.86SD 4.12±0.59SD < 0.001
[Non-emergency preparedness] How would you
rate your comfort level participating in a non-
emergent care situation in your area of expertise
in the new unit? 3.93±1.00SD 4.38±0.65SD 0.035
[Emergency preparedness] How would you rate
your comfort level participating in an
emergent/critical care situation in your area of
expertise in the new unit? 3.84±0.87SD 4.31±0.65SD 0.027
[Training and role definition] How would you rate
your confidence level working in this new unit in
your defined role before simulation? 3.46±0.84SD 4.30±0.66SD <0.001
[Institutional preparation] How would you rate your
confidence level with the institution's work to
prepare you for the move into the new unit before
simulation? 3.41±1.05SD 4.38±0.60SD <0.001
NEW UNIT PRE- AND POST-SIMULATION SURVEY RESULTS
Table 2. Pre- and Post-Simulation Survey Results Fig 5. Pre- and Post-Simulation Comparison Chart
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