• Aarti Sarwal, Nicholas A Morris, Janet Crumpler, Terri Gordon, Ian Saunders, James E Johnson, and Jeff E Carter.
• Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC.
• Crit. Care Med. 2024 Jul 1; 52 (7): e351e364e351-e364.

ObjectivesTransitions 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.DesignDescriptive review of a patient safety initiative.SettingA newly built 24-bed neurocritical care unit at a tertiary care academic medical center.SubjectsCare providers working in neurocritical care unit.InterventionsWe 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.Measurements And Main ResultsWe 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.ConclusionsIn situ simulation effectively identifies latent safety threats surrounding the transition to new ICUs and should be considered before moving into new units.Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

11 keywords...

hide…