Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC.
Department of Neurology, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD.
Crit Care Med. 2024 Jul 1;52(7):e351-e364. doi: 10.1097/CCM.0000000000006256. Epub 2024 Mar 27.
Transitions to new care environments may have unexpected consequences that threaten patient safety. We undertook a quality improvement project using in situ simulation to learn the new patient care environment and expose latent safety threats before transitioning patients to a newly built adult ICU.
Descriptive review of a patient safety initiative.
A newly built 24-bed neurocritical care unit at a tertiary care academic medical center.
Care providers working in neurocritical care unit.
We implemented a pragmatic three-stage in situ simulation program to learn a new patient care environment, transitioning patients from an open bay unit to a newly built private room-based ICU. The project tested the safety and efficiency of new workflows created by new patient- and family-centric features of the unit. We used standardized patients and high-fidelity mannequins to simulate patient scenarios, with "test" patients created through all electronic databases. Relevant personnel from clinical and nonclinical services participated in simulations and/or observed scenarios. We held a debriefing after each stage and scenario to identify safety threats and other concerns. Additional feedback was obtained via a written survey sent to all participants. We prospectively surveyed for missed latent safety threats for 2 years following the simulation and fixed issues as they arose.
We identified and addressed 70 latent safety threats, including issues concerning physical environment, infection prevention, patient workflow, and informatics before the move into the new unit. We also developed an orientation manual that highlighted new physical and functional features of the ICU and best practices gleaned from the simulations. All participants agreed or strongly agreed that simulations were beneficial. Two-year follow-up revealed only two missed latent safety threats.
In situ simulation effectively identifies latent safety threats surrounding the transition to new ICUs and should be considered before moving into new units.
新的护理环境的过渡可能会产生意想不到的后果，威胁患者安全。我们开展了一项质量改进项目，使用现场模拟来了解新的患者护理环境，并在将患者转移到新建成的成人 ICU 之前暴露潜在的安全威胁。
患者安全计划的描述性回顾。
一家三级保健学术医疗中心新建的 24 张床位神经重症监护病房。
在神经重症监护病房工作的护理人员。
我们实施了一个实用的三阶段现场模拟计划，以了解新的患者护理环境，将患者从开放式病房转移到新建成的私人房间为基础的 ICU。该项目测试了由单位新的以患者和家庭为中心的功能创建的新工作流程的安全性和效率。我们使用标准化患者和高保真人体模型来模拟患者场景，并通过所有电子数据库创建“测试”患者。来自临床和非临床服务的相关人员参与模拟和/或观察场景。我们在每个阶段和场景后进行汇报，以确定安全威胁和其他问题。通过发送给所有参与者的书面调查获得了额外的反馈。我们在模拟后 2 年内前瞻性地调查潜在安全威胁的遗漏情况，并在出现问题时及时解决。
我们在搬入新单元之前确定并解决了 70 个潜在的安全威胁，包括与物理环境、感染预防、患者工作流程和信息学相关的问题。我们还编写了一份介绍手册，突出了 ICU 的新物理和功能特性以及从模拟中获得的最佳实践。所有参与者都同意或强烈同意模拟是有益的。两年的随访仅发现了两个潜在安全威胁的遗漏。
现场模拟可有效确定新 ICU 过渡期间的潜在安全威胁，应在搬入新单元之前考虑。
