A Simulation Systems Testing Program Using HFMEA Methodology Can Effectively Identify and Mitigate Latent Safety Threats for a New On-Site Helipad.

BACKGROUND: Fundamental changes in critical systems within hospitals present safety risks. Some threats can be identified prospectively, others are only uncovered when the system goes live. Simulation and Healthcare Failure Mode and Effect Analysis (HFMEA) can be used together to prospectively test a system without endangering patients. The research team combined iterative simulations and HFMEA methodologies to conduct simulation-based clinical systems testing (SbCST) to detect and mitigate latent safety threats (LSTs) prior to opening a hospital helipad. METHODS: This study was conducted in three phases. In Phase I, an interprofessional team created a process map and conducted a tabletop exercise, identifying LSTs that could theoretically occur during patient transfer from the new helipad. Using HFMEA methodology, steps predicted to be affected by the new helipad were probed. Identified LSTs were assigned a hazard score. Mitigation solutions were proposed. Results from Phase I were used to plan Phase II, which used low-fidelity simulation to test communication processes and travel paths. High-fidelity simulation was used in Phase III to test previously identified LSTs. RESULTS: Over three testing phases, 31 LSTs were identified: 15 in Phase I, 7 in Phase II, and 9 in Phase III. LSTs fell under the categories of care coordination, facilities, and equipment, and devices. Eighteen (58.1%) were designated "critical" (hazard score ≥ 8). CONCLUSION: A three-phase SbCST program using HFMEA methodology was an effective tool to identify LSTs. An iterative approach, using results of each phase to inform the structure of the next, facilitated testing of proposed mitigation strategies.

Factors associated with interprofessional engagement in debriefing following pediatric simulation-based team training.

Simulation offers a high fidelity modality to deliver and study team-based interprofessional education. Debriefing the following simulated scenarios is a critical component of this training. Little data exist to inform best practices to optimize interprofessional engagement during debriefing. This pilot study analyzed interprofessional debriefing events following 20 pediatric simulation-based team trainings to identify associations between modifiable factors and learner engagement. Reviewers observed a total of 236 learners, using a previously published tool to assess learner engagement. Data related to the scenario, debriefing, learners, and facilitators were collected. Spearman's correlation was used to analyze the association between factors of interest and average learner engagement scores for each debriefing event. Mean engagement did not differ between physicians and nurses, but was lower for other professionals. Average learner engagement was inversely related to learner group size, but not to the proportion of learners in each profession. Oral participation differed significantly between professions for both learners and co-facilitators, with physicians speaking more in both groups. Students of all professions had lower engagement and spoke less frequently. This study identifies several modifiable factors, including total group size, learner level, and facilitator behavior that were associated with interprofessional engagement during debriefing following simulation-based team training.