From the Division of Emergency Medicine, Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
Simul Healthc. 2011 Jun;6(3):125-33. doi: 10.1097/SIH.0b013e31820dff30.
: Our institution recently opened a satellite hospital including a pediatric emergency department. The staffing model at this facility does not include residents or subspecialists, a substantial difference from our main hospital. Our previous work and published reports demonstrate that simulation can identify latent safety threats (LSTs) in both new and established settings. Using simulation, our objective was to define optimal staff roles, refine scope of practice, and identify LSTs before facility opening.
: Laboratory simulations were used to define roles and scope of practice. After each simulation, teams were debriefed using video recordings. The National Aeronautics and Space Administration-Task Load Index was completed by each participant to measure perceived workload. Simulations were scored for team behaviors by video reviewers using the Mayo High Performance Team Scale. Subsequent in situ simulations focused on identifying LSTs and monitoring for unintended consequences from changes made.
: Twenty-four simulations were performed over 3 months before the hospital opening. Laboratory debriefing identified the need to modify provider responsibilities. National Aeronautics and Space Administration-Task Load Index scores and debriefings demonstrated that the medication nurse had the greatest workload during resuscitations. Modifying medication delivery was deemed critical. Lower Mayo High Performance Team Scale scores, implying less teamwork, were noted during in situ simulations. In situ sessions identified 37 LSTs involving equipment, personnel, and resources.
: Simulation can help determine provider workload, refine team responsibilities, and identify LSTs. This pilot project provides a template for evaluation of new teams and clinical settings before patient exposure.
我们的机构最近开设了一家卫星医院，其中包括儿科急诊室。该设施的人员配备模式不包括住院医师或专科医生，这与我们的主要医院有很大的不同。我们之前的工作和已发表的报告表明，模拟可以在新的和已建立的环境中识别潜在的安全威胁（LST）。我们使用模拟的目的是在设施开业前确定最佳人员角色、完善实践范围，并识别 LST。
实验室模拟用于定义角色和实践范围。每次模拟后，团队都会使用视频记录进行汇报。每位参与者都使用 NASA 任务负荷指数完成了工作量的评估。视频评论员使用 Mayo 高绩效团队量表对团队行为进行模拟评分。随后的现场模拟侧重于识别 LST 并监测因更改而产生的意外后果。
在医院开业前的 3 个月内进行了 24 次模拟。实验室汇报确定需要修改提供者的责任。NASA 任务负荷指数评分和汇报表明，在复苏过程中，药物护士的工作量最大。修改药物输送被认为是关键的。现场模拟中， Mayo 高绩效团队量表的得分较低，表明团队合作较少。现场会议确定了涉及设备、人员和资源的 37 个 LST。
模拟可以帮助确定提供者的工作量、完善团队职责，并识别 LST。这个试点项目为在患者暴露之前评估新团队和临床环境提供了模板。
