227 - Testing Travel Paths and Processes to and from a new Cardiac Tower Using Healthcare Failure Mode and Effects Analysis and In-Situ Simulation

Publication Number: 227.6947

Dani Bruno, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, United States; Marissa Perry, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, United States; Micheline Chipman, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, United States; Sophia Martens, Tufts University School of Medicine, Scarborough, ME, United States; Lauren Weller, Tufts University School of Medicine, Portland, ME, United States; Leah Mallory, Barbara Bush Children’s Hospital, Portland, ME, United States

Background: Adapting to new clinical environments often involves complex workflow changes that can affect patient safety. Simulation is increasingly used for systems testing, enabling proactive rather than reactive analysis to promote patient safety.1 Using structured methods like Healthcare Failure Mode and Effects Analysis (HFMEA) with in-situ simulation helps teams to practice and probe processes before the opening of new environments to identify and mitigate latent safety threats.2

Objective: To use HFMEA with in-situ simulation to probe paths of travel of critically ill pediatric patients to a new cardiac tower and to identify and mitigate latent safety threats prior to opening.

Design/Methods: An interprofessional team of stakeholders assembled and identified concerns about transporting pediatric inpatients to and from intensive care units to procedural suites in the new tower. We utilized in-situ simulation with structured debriefing, evaluating three paths of travel: NICU to the cardiac procedure lab and two from the pediatric OR to the PICU (one involving ECMO). Key priorities included transport time, exposure to the public or staff, and temperature control. After each simulation, a debrief was conducted and latent safety threats (LST)s were identified, categorized, and scored (Table 1). Protective factors were also noted.

Results: A total of 41 participants including physicians (cardiac surgeons, pediatric intensivists, neonatologist, anesthesiologists), nurses, advanced practice providers, respiratory therapists, perfusionists, and administrators participated in the simulations and debriefs. A total of 44 LSTs were identified with 12 deemed “critical” (scoring ≥8) and nine which were common to all three scenarios (Table 2). 91% of LSTs were linked to systemic issues (care coordination, equipment, and facilities), with very few threats in teamwork or clinical skill. Additionally, 13 protective practices were documented (Table 3).

Conclusion(s): HFMEA methodology and in-situ simulation effectively identified LSTs in pediatric transitions to a new clinical space where potentially long transport times for critically ill patients were a concern. Post-simulation debriefs emphasized protective processes and initiated mitigation strategies. Using in-situ simulation and HFMEA before occupancy of the new building facilitated the development of solutions before patient care began.
References
1.Phrampus, Simulation and Integration into Patient Safety Systems 13(4):225-226.
2.Francoeur et al., It Takes a Village to Move a Hospitaln8(3):148-156.

HFMEA Hazard Scoring Based on Severity and Probability


Identified LSTs Common to all Three Scenarios


Protective Factors to Mitigate Potential Harm