Große Lordemann Anja, Sommerfeldt Dirk, Mileder Lukas
Altonaer Kinderkrankenhaus gGmbH, Hamburg, Deutschland; Netzwerk Kindersimulation e.V, Tübingen, Deutschland.
Altonaer Kinderkrankenhaus gGmbH, Hamburg, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2024 Jun;187:15-21. doi: 10.1016/j.zefq.2024.03.005. Epub 2024 Apr 21.
Structured emergency room concepts have been shown to contribute to patient safety. Until now there has been no uniform emergency room concept for critically ill and seriously injured children and adolescents in the emergency room at the Altona Children's Hospital in Hamburg. This concept has been newly developed in interdisciplinary cooperation and includes the use of new clinical premises as well as new responsibilities and team compositions. The introduction of new processes and rooms for handling emergencies is associated with a risk of overlooking latent safety deficiencies or detecting them only after the process has been implemented. This may have a direct impact on patient safety. Before moving to new clinical premises, in situ simulation can be helpful to identify and to resolve latent safety threats in advance. Therefore, this method was chosen to test the newly created emergency room concept in the future emergency room at the Altona Children's Hospital.
Two in situ simulations were carried out in the future real emergency room. Latent safety threats detected by the observation team and the participants (medical and nursing staff of the Altona Children's Hospital from the departments of pediatric surgery, traumatology, orthopedics, pediatrics, anesthesia, intensive care medicine, radiology, emergency medicine) were collected using free text notes after the simulations and evaluated retrospectively. In order to better deal with these latent safety threats, the observations were classified into different categories: working environment (e.g., lack of equipment, unfavorable positioning of material), process (e.g., lack of defined responsibilities in the team) and other safety threats that did not fall into one of the two categories defined.
A total of 51 latent safety threats were identified during the two in situ simulations. Of these, 22 (43.1%) were assigned to the "working environment" category, 20 (39.2%) to the "process" category and 9 (17.7%) to the "other safety threats" category. Of the latent safety threats identified, 46 (90.2 %) could be resolved before the emergency room was put into operation. For the non-recoverable safety threats, safety concepts were developed in order to further minimize the risk of patient hazard.
With the help of this study, it could be shown that the implementation of in situ simulation before the commissioning of new clinical premises and the introduction of new processes can contribute to the detection of latent safety threats in an interdisciplinary German pediatric emergency department.
结构化急诊室概念已被证明有助于患者安全。到目前为止，汉堡阿尔托纳儿童医院急诊室尚未针对危重症及重伤儿童和青少年制定统一的急诊室概念。该概念是通过跨学科合作新开发的，包括使用新的临床场所以及新的职责和团队构成。引入新的急诊处理流程和空间存在忽视潜在安全缺陷或仅在流程实施后才发现这些缺陷的风险。这可能会对患者安全产生直接影响。在迁至新的临床场所之前，现场模拟有助于提前识别并解决潜在的安全威胁。因此，选择此方法在阿尔托纳儿童医院未来的急诊室中测试新创建的急诊室概念。
在未来实际的急诊室中进行了两次现场模拟。模拟结束后，通过自由文本记录收集观察团队和参与者（阿尔托纳儿童医院小儿外科、创伤科、骨科、儿科、麻醉科、重症医学科、放射科、急诊科的医护人员）发现的潜在安全威胁，并进行回顾性评估。为了更好地应对这些潜在安全威胁，将观察结果分为不同类别：工作环境（如设备不足、物资摆放不利）、流程（如团队中职责不明确）以及不属于上述两类的其他安全威胁。
在两次现场模拟中总共识别出51个潜在安全威胁。其中，22个（43.1%）属于“工作环境”类别，20个（39.2%）属于“流程”类别，9个（17.7%）属于“其他安全威胁”类别。在识别出的潜在安全威胁中，46个（90.2%）在急诊室投入使用前得以解决。对于无法解决的安全威胁，制定了安全概念以进一步降低对患者造成危害的风险。
通过本研究可以表明，在新临床场所启用和新流程引入之前实施现场模拟有助于在德国一家跨学科儿科急诊科中检测潜在安全威胁。
