Kobayashi Leo, Shapiro Marc J, Sucov Andrew, Woolard Robert, Boss Robert M, Dunbar Jennifer, Sciamacco Ronald, Karpik Kelly, Jay Gregory
Department of Emergency Medicine, Brown Medical School, Providence, RI, USA.
Acad Emerg Med. 2006 Jun;13(6):691-5. doi: 10.1197/j.aem.2006.01.023. Epub 2006 Apr 24.
Efforts to mitigate unexpected problems during transition of an active emergency department (ED) to a new physical plant are imperative to ensure effective health care delivery and patient safety. The authors used advanced medical simulation (SIM) to evaluate the capacity of a new ED for emergent resuscitative processes and assist facility orientation before opening day.
Operational readiness testing and orientation to the new ED of a large academic center were arranged through a Transportable Enhanced Simulation Technologies for Pre-Implementation Limited Operations Testing (TESTPILOT) project. Using a portable life-sized computerized manikin, the project required participants to perform assorted patient care interventions on-site. Cardiac arrest, multitrauma, uroseptic shock, and pediatric toxicology scenarios elicited the dynamics of real-life ED activities. Debriefings and surveys assessed participants' perceptions of the new facility's clinical readiness and identified areas needing administrative attention. Subjective utility of SIM orientation was compared with that of standard facility orientation.
Fourteen ED clinicians and five SIM facilitators participated over two sessions. The new facility received mean (+/- SD) and median five-point Likert scale scores of 4.4 (+/- 0.8) and 5 for ability of clinical staff to perform resuscitations. The respective scores for ability of simulated scenarios to prepare staff for new ED function were 4.6 (+/- 0.5) and 5, compared with 4.2 (+/- 1.0) and 4 for non-SIM orientation (p = 0.22; not significant). Problems with equipment location, inadequate procedural surfaces, and insufficient orientation were discovered and rapidly corrected.
Transportable SIM was used to evaluate the clinical functions of a new ED. Significant operational issues identified by participants were corrected before opening of the facility. Limited comparison did not reveal SIM enhancement of orientation.
在将现有的急诊科（ED）转移到新的物理场所期间，努力减轻意外问题对于确保护理服务的有效性和患者安全至关重要。作者使用先进的医学模拟（SIM）来评估新急诊科进行紧急复苏流程的能力，并在开业前协助进行设施定位。
通过一个用于实施前有限运营测试的便携式增强模拟技术（TESTPILOT）项目，安排了对一个大型学术中心新急诊科的运行准备测试和定位。该项目使用一个便携式真人大小的计算机化人体模型，要求参与者在现场进行各种患者护理干预。心脏骤停、多发伤、尿脓毒症休克和儿科毒理学场景引发了现实生活中急诊科活动的动态情况。汇报和调查评估了参与者对新设施临床准备情况的看法，并确定了需要行政关注的领域。将SIM定位的主观效用与标准设施定位的主观效用进行了比较。
在两个场次中，共有14名急诊科临床医生和5名SIM协调员参与。新设施在临床工作人员进行复苏能力方面的平均（±标准差）和中位数五点李克特量表得分分别为4.4（±0.8）和5。模拟场景使工作人员为新急诊科功能做好准备的能力得分分别为4.6（±0.5）和5，而非SIM定位的得分分别为4.2（±1.0）和4（p = 0.22；无显著差异）。发现了设备位置、操作台面不足和定位不够等问题，并迅速进行了纠正。
使用便携式SIM来评估新急诊科的临床功能。参与者发现的重大运行问题在设施开业前得到了纠正。有限的比较未显示SIM增强了定位效果。
