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Testing Patient Spaces before the Walls are Built

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The new Jennie Sealy hospital is a $438 million facility with 310 patient rooms, 54 ICU rooms, 28-bed day surgery units, and 20 state-of-the-art operating suites.

Based on the research principle of intervention and outcome, it came to our attention that in order to adequately test the space, a design validation exercise using simulation in realistic activities would be beneficial before the actual walls were built.

Our research revealed that this might be a unique experience, and full-scale, realistic mockups constructed by a design team included: a Med-Surg room; ICU room; operating suite; and transport elevator.

Surveys were taken and ideas were considered, but it remained a static exercise.

Objectives included:
Identify design inadequacies of a proposed new hospital (space, distance, placement of equipment, booms, etc.)
Identify latent environmental threats to patient safety (e.g., poorly designed patient environments, plugs, suction and oxygen lines, etc.)
Evaluate work flow (using room design for activities of daily living, placement of nursing station, Pyxis machine, code cart, etc.)

Participants included 50 staff members:
Nurses (Med-Surg, ICU, OR)
Physicians (Surgery, Anesthesiology, Internal Medicine)
Rapid Response Team
Code Team
Rehab Services
Employee Injury Management
IT
Nursing Education
Medical Education
Quality Management
Administration

15 students:
School of medicine
School of nursing
School of health professions

Methods used:
A design validation exercise using simulation and its five components:
Planning
Briefing
Simulation
Debriefing
Follow-up/mitigation

To evaluate:
Design
Functionality
Patient safety
Use of equipment
Patient flow
Work flow

Simulation of lifelike emergent situations using a SimMan4g:
Med-Surg
3-day post op CABG patient named George deteriorated requiring rapid response team (code team).
Code cart and intubation, transferred with full team to ICU through full scale elevator
ICU
ET tube dislodged during transport requiring re-intubation and CXR
Patient was subsequently placed on ventilator and ECMO
Re-entry cart brought to room from OR, transferred with full team to OR CT room
OR
Cardiac surgery was simulated in a mock cardiothoracic room
X-ray performed

Data Gathering:
All participants were asked to record their thoughts, feelings, and concerns after each scenario.
Debriefing sessions were held in each room after the scenario was completed
Staff feedback was recorded on a poster
Quality staff grouped and summarized findings
Summary was confirmed with the planning committee

Outcomes:
Front-line staff conducted interactive Failure Mode and Effects Analysis (FMEA)
“Test-drive” new space in a series of critical situations
Staff recommendations passed to administration, as well as the construction/planning team
Influenced equipment purchase
Multidisciplinary representation showed why features were key to some groups and useless to others
Understanding of the design aspects that can’t be changed—and the policies and procedures needed to address them

Interprofessional exercise:
Recognizing that emergent episodes represent a small percentage of daily hospital routine, the afternoon was spent in an interprofessional exercise to evaluate the normal routine of daily activity
Fifteen students from respiratory therapy, nursing, and medicine performed routine activities of daily living in the Med-Surg room
A trained, live, standardized patient was used to simulate the routine activities of daily care. The multi-disciplinary students worked together to provide that care
The purpose of the simulation was to assess the ergonomics of the proposed rooms and to identify latent environmental variables that posed threats to patient or staff safety during the routine events of a typical patient day