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Background: The COVID-19 prompted pediatric emergency departments (PED) to prepare for a surge in patients. In response, guidelines developed represent “work as imagined” and may not reflect work as done. In situ simulations could identify gaps and help to mitigate errors. Simulation-based clinical systems tests (SbCSTs) can detect latent safety threats (LSTs) in systems design.

Objective: Our aim was to use SbCSTs combined with rapid cycle training to test hospital system modifications for ED preparation. This method represenst a new application of SbCSTs. The research questions were in 2 frames: 1. Can rapidly deployed SbCSTs identify LSTs and recommendations for improvement and 2. Do providers consider rapid SbCSTs a way to improve preparedness?

Design/Methods: The study took place in a PED and was approved by the IRB as non-human subject research. SbCST scenarios tested guidelines/job aids, equipment, and ways to mitigate exposure. Each case used “tipping-point”(s) to test workflow. Short scripted debriefs reviewed guidelines, staff input, and the simulation repeated. Participants evaluated the SbCST with a survey. Three sim staff collected observations on a standardized form for which process was tested, staff response, and LSTs identified.

Results: Question 1. LST identification: From the 44 simulations, 64 staff identified 103 unique LSTs. LSTs were categorized as follows: Job Aids/tasks 37 (36%), Isolation Measures (PPE) 30 (29%), Communication/personnel: 18 (17.5%), and Equipment 18 (17.5%). Common LSTs identified: In the Job Aid category: simplify intubation job aid, Isolation Measures: staff had concerns about PPE changes prior to generating aerosol, Equipment: adjust equipment needs to avoid delays, and change PPE, and Communication/Personnel: minimizing staff during resuscitations. Question 2. Staff evaluations (strongly agree, (SA) to strongly disagree, (SD)): Worth the time it took: 86% SA, 14% some what agreed (SWA). An acceptable way to improve: 92 % SA, 8% SWA. An effective way to test: 92% SA, 8% SWA. Debriefing allowed staff to share ideas: 86% SA SWA 8%, and Average 6%.

Conclusion(s): This study showed that SbCST methods are adaptable for preparedness evaluation and training. Participant evaluations reveal a high regard for this method for practicing/improving the COVID-19 process. This work highlights a new application of SbCSTs that could increase system preparedness and reduce errors.

Presented at the 2021 PAS Virtual Conference


Emergency Medicine | Nursing | Pediatrics

Simulation Based Clinical Systems Testing in the Pediatric Emergency Department to Prepare for COVID-19 Pandemic