Department of Pediatrics, Women & Infants' Hospital, Providence, RI 02905, USA.
Simul Healthc. 2011 Aug;6(4):204-12. doi: 10.1097/SIH.0b013e3182183c0b.
Transition of a Neonatal Intensive Care Unit (NICU) to a new physical plant incurs many challenges. These are amplified when the culture of care is changing from traditional cohort-based care to the single-family room model. Altered healthcare delivery systems can be tested in situ with TESTPILOT: Transportable Enhanced Simulation Technologies for Pre-Implementation Limited Operations Testing. The aims of the study included promoting translation of existing processes and identifying staff orientation material. We hypothesized that (1) numerous process gaps would be discovered and resolved, and (2) participants would feel better prepared.
A functional neonatal intensive care unit was modeled before its opening. Scenarios were developed, volunteers recruited, and rooms supplied with equipment. Participants performed usual duties in two 30-minute in situ simulations followed by facilitated debriefings. As latent safety hazards were identified, they were corrected and retested in subsequent simulations. Staff was surveyed for perceived preparedness.
Ninety-six multidisciplinary participants identified 164 latent safety hazards in verbal and written communication, facilities, supplies, staffing, and training, 93% of which were resolved at transition. Staff preparedness varied but showed improving communication, workflow patterns, and awareness of equipment and supply locations. The majority stated that this simulation experience changed their practice.
Simulation is very effective for identifying process gaps before major institutional change. TESTPILOT generated iterative workflow enhancements and staff orientation toward improving patient care at transition and beyond. The extensive coordination required to implement such large-scale simulations is well worth the benefit for systems refinement and patient safety.
新生儿重症监护病房（NICU）向新的物理环境过渡会带来许多挑战。当护理文化从传统的队列式护理转变为单间病房模式时，这些挑战会更加严重。可以使用 TESTPILOT（可运输增强模拟技术，用于预实施有限操作测试）在现场测试改变后的医疗保健提供系统。该研究的目的包括促进现有流程的转化和确定员工上岗材料。我们假设：（1）会发现并解决许多流程差距，（2）参与者会感到更有准备。
在新的 NICU 开业前，建立了一个功能齐全的模型。开发了各种场景，招募了志愿者，并为房间配备了设备。参与者在两次 30 分钟的现场模拟中执行了通常的任务，然后进行了有指导的讨论。当发现潜在的安全隐患时，会在后续的模拟中进行纠正和重新测试。对员工的准备情况进行了调查。
96 名多学科参与者在口头和书面沟通、设施、用品、人员配备和培训方面发现了 164 个潜在的安全隐患，其中 93%在过渡期间得到了解决。员工的准备情况有所不同，但在沟通、工作流程模式以及对设备和供应位置的认识方面有所提高。大多数人表示，这种模拟体验改变了他们的实践。
模拟对于在重大机构变革之前识别流程差距非常有效。TESTPILOT 产生了迭代的工作流程增强和员工上岗培训，以改善过渡期间和之后的患者护理。实施此类大规模模拟所需的广泛协调非常值得进行系统改进和保障患者安全。
