PC3120: Multidisciplinary in Situ Simulation to Identify Latent Safety Threats Prior to Opening Two New Medical Imaging Spaces

Purpose/Objectives: Pediatric patients undergoing procedures in interventional radiology (IR) and magnetic resonance imaging (MRI) suites encompass a wide spectrum of ages and medical complexities. These physical spaces must therefore be optimized to ensure that multidisciplinary teams work cohesively together and that systems, pathways, and processes support and enhance patient care within that space. Our objectives were to use simulation to: (1) assess and optimize workflows into, within, and out of our new IR and MRI suites and (2) identify any needed modifications to our 2 new spaces prior to their opening. We hypothesized that simulation would help identify latent safety threats that could be resolved prior to opening these new spaces.

Design/Methods: Simulation leadership held needs assessment meetings with key stakeholders including representatives from radiology, critical care, sedation, anesthesia, construction project management, plant operations, and information systems clinical applications. Collaboratively designed scenarios included routine sedated and non-sedated patients as well as decompensating patients requiring escalation of care and mobilization of resources. Scenario objectives involved safe patient transfer into and out of each space, optimal flow within each space, and space assessments. Multidisciplinary teams took part in each in-situ scenario.
Latent safety threats (LSTs) and recommendations were identified and recorded during the debriefs that followed each scenario and the end of each session. Detailed reports were given to leadership and key stakeholders. Key stakeholders then assigned criticality to each item and identified countermeasures and individuals responsible for implementing and enforcing the countermeasures. Resolution dates were documented and key stakeholders returned completed reports to the simulation team for full loop closure and bi-directional feedback.

Results: 19 participants took part in a total of 5 IR simulation scenarios. 4 scenarios were routine and 1 was a code. 48 LSTs were identified (23 high criticality, 17 medium and 8 low). Teams identified 6 additional LSTs post simulation. Stakeholders identified and completed countermeasures within 4 weeks. Examples of high criticality LSTs included technology interface issues.
21 participants took part in a total of 4 MRI simulation scenarios. 2 scenarios were routine and 2 involved patient decompensation. 39 LSTs were identified (24 high, 5 medium, 10 low). Teams identified 8 additional LSTs post simulation. Stakeholders identified and completed countermeasures within 2 weeks. Examples of high criticality LSTs included processes to remove a coding patient from the ferrous environment as well as routes to the new space.

Conclusion/Discussion: Our simulations identified LSTs and processes that were addressed and improved upon prior to opening our 2 new spaces. We believe that this model of using simulation to integrate teams into a new space was successful and encourage this approach with future endeavors. Ongoing analysis is needed to see if recommended and implemented changes are sustained over time.