Miller Briana D, Bloom Andrew D, Kons Helena, White Marjorie Lee
Jt Comm J Qual Patient Saf. 2025 Jul-Aug;51(7-8):458-465. doi: 10.1016/j.jcjq.2025.02.007. Epub 2025 Mar 1.
In the era of extreme emergency department (ED) boarding, hospital systems are using novel patient care areas to provide ongoing acute care. In any new patient care environment, there is a high risk for latent safety threats (LSTs), which can negatively affect patient outcomes. A series of in situ systems-based simulations were conducted to identify potential LSTs prior to the opening of a novel mobile care unit (MCU) in a tertiary hospital.
After a needs assessment in conjunction with institutional leadership, a series of in situ interprofessional simulation sessions were developed to represent realistic scenarios in the MCUs. Simulations included low-frequency high-acuity patient care scenarios as well as high-frequency day-to-day encounters. Data were collected in structured systems-based debriefing sessions via trained observers, video recordings, and participant surveys, with a primary outcome of identifying potential LSTs. The LSTs were categorized and then stratified using the Survey Analysis for Evaluating Risk (SAFER) Matrix. One simulation was repeated after mitigation strategies were employed by institutional leadership.
A total of 117 staff participated in five simulation sessions. In the first round of simulations, 37 LSTs were identified, primarily in the categories of Environment/Wayfinding (13/37, 35.1%) and Communication (6/37, 16.2%). LSTs risk stratified using the SAFER Matrix provided prioritized feedback for hospital leadership to guide mitigation strategies prior to the opening of the new units. One LST was initially classified as high likelihood to harm on the SAFER Matrix. The simulated scenario involving this LST was repeated two weeks later with no further high-risk LSTs identified.
In situ simulations can serve as an effective tool to identify potential LSTs prior to the opening of novel patient care spaces.
在急诊科极度拥堵的时代，医院系统正在使用新型患者护理区域来提供持续的急性护理。在任何新的患者护理环境中，都存在潜在安全威胁（LST）的高风险，这可能会对患者的治疗结果产生负面影响。在一家三级医院开设新型移动护理单元（MCU）之前，进行了一系列基于现场系统的模拟，以识别潜在的LST。
在与机构领导进行需求评估后，开发了一系列基于现场的跨专业模拟课程，以呈现MCU中的实际场景。模拟包括低频高 acuity 患者护理场景以及高频日常情况。通过训练有素的观察员、视频记录和参与者调查，在基于系统的结构化汇报会议中收集数据，主要结果是识别潜在的LST。使用评估风险的调查分析（SAFER）矩阵对LST进行分类，然后分层。在机构领导采取缓解策略后，重复进行了一次模拟。
共有117名工作人员参加了五次模拟课程。在第一轮模拟中，识别出37个LST，主要集中在环境/寻路（13/37，35.1%）和沟通（6/37，16.2%）类别中。使用SAFER矩阵对LST进行风险分层，为医院领导提供了优先反馈，以指导新单元开放前的缓解策略。在SAFER矩阵上，最初有一个LST被归类为高伤害可能性。两周后，重复了涉及此LST的模拟场景，未发现进一步的高风险LST。
现场模拟可以作为一种有效的工具，在新型患者护理空间开放之前识别潜在的LST。
