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Table 2 Summary of findings and recommendations

From: Commissioning simulations to test new healthcare facilities: a proactive and innovative approach to healthcare system safety

Element/area Findings Recommendations Actioned
Provider/team issues provider
Roles and scope of practice
Emergency department (ED)
Med Surg
OB units
• Trauma room/code team formation physicians, respiratory therapist and paramedics in code room, overlapping skill set and roles.
• Team composition—addition of health care aid (unregulated) to units lack of understanding of scope (too much to little), partnership with RNs, lack of acute care hospital experience.
• Simulation teamwork training for identifying leader, role clarity, and communication.
• Simulation teamwork training/orientation classroom for role clarity and communication.
• First year post-opening focused on team simulations. Elimination of paramedic role
• Monthly simulation with IP teams continue in trauma bays
• OB Sims monthly nursing
  • No OB on site until September 2014/ ED open January 2013. • Expand NRP training to ED staff.
• Need for precipitous delivery equipment and supplied in ED staff.
• OB orientation day for ED occurred December 2012
• Equipment and supplies arrived prior to opening
Clinical proficiencies
Inpatient units
ICU code team
• Medications—code team unable to access automatic dispensing cabinets on units.
• No crash carts/defibrillators/code team prior to January 2013.
• Orientate nursing staff on role in accessing meds for code team.
• Development of airway buckets pre ICU with AED training for staff.
• Protocols placed in high acuity areas
• Completed
• Airway buckets in effect from 2012 (dismantled with full operation of ICU operational in 2013)
• Signage/resources created
Facility issues
All units
OB
• Code Red/Blue/power outage outside of fire department override during Code Blue; code team over team to use the stairs.
• Dedicated OB elevators/OB 7th floor OR on 3rd floor
• Awareness, key to be given to facilities management
• ID need to transfer sled to transport OB patients in need of STAT C-section/OR resuscitation
• Need for C-section set up on 7th floor
• Key obtained
• Site wide fire drills maintained yearly
• Transfer sleds obtained
• Confidence in elevators/system—not completed
Communication
Inpatient units
ICU code team
Public areas
• Mis-wiring of Code Blue/staff assist buttons
• No cell service/outside telephones in hallways for calls on site prior to mid-August 2012
• Immediate follow-up with vendor and facilities management
• Staff awareness campaign for accessing hard-wired phones locations
• Wirings fixed and tested prior to opening
• New phone lines for main street kiosks
Unintended consequences
EMS
• EMS not aware of how to access hospital for pre ED opening • Tours for all Calgary EMS providers to site • Completed by October 2012
Emergency department • Code room setup, pillars hinder access to med cupboards. • Reconfiguration of carts and trauma room to better serve needs • Re-configuring and changing of supply carts and resources completed
Adolescent mental health • Asphyxiation/hanging of mannequin in simulation accomplished in high observation unit • Management and staff awareness for need to constant observation, patient placement • Grates fixed by FM and E, staffing and patient assignments changed
Pediatric outpatient clinic • Pediatric Code Blue lack of pediatric supplies for code blue. No medications available in clinics, lack of specialty knowledge for pediatric crisis • Identified need to “pack and go” to trauma bay in ED ASAP, meds added to RT outreach bag, stretcher brought to unit for potential transfers • New pediatric backpack and supplies
• Assigned situational role to ICU nurse to recommend when transfer needs to occur