What happens when a multidisciplinary team engages in 32 hours of simulated-based design tests on patient care spaces inside a mocked-up “critical care” warehouse? More than 100 latent safety threats are detected before construction begins.
As part of the Pediatric Tower E vertical expansion project, Texas Children’s Simulation Center and the CareFirst Quality, Service and Safety (QSS) Project Team coordinated a series of high-risk patient care scenarios to drive the design of the space for the patient rooms in the cardiovascular intensive care unit (CVICU), pediatric intensive care unit (PICU) and the progressive care unit (PCU).
“A specific concern in a new healthcare facility or patient care process is the existence of unrecognized or latent threats to safety that could affect actual patients once the facility opens,” said Texas Children’s Simulation Center Medical Director Dr. Jennifer Arnold. “Simulation allows us to test patient care spaces before final design decisions are made to avoid costly mistakes that could potentially impact patient safety, patient/family experience and provider satisfaction. To make modifications after a facility is built can be very expensive or sometimes even impossible.”
Following a needs assessment to identify the high-priority areas for testing of the new space, patient care simulations including the worst case scenario in the intensive care unit were conducted inside a large warehouse mock-up that resembled a critical care environment. A multidisciplinary team of intensivists, nurses, surgeons, anesthesiologists, respiratory therapists, patient families and other clinical support staff, participated in the four-day simulations and provided their feedback.
“I was involved on the PICU and PCU days and the staff who participated made me so proud,” said Texas Children’s Clinical Care Nursing Director Shannon Holland. “They were engaged and committed to ensuring we create the best possible environments to care for our patients and their families.”
During these simulations, 115 latent safety threats were identified and categorized based on Safe Hospital Design Principles outlined by the Agency for Healthcare Research and Quality.
Recommendations for design were received on the areas below. Clinicians prioritized recommendations and are continuing to work with the design team to incorporate into the final design.
- Visibility into room
- Visibility and monitoring between rooms
- Equipment and technology placement within room
- Storage solutions within room
- Family space design
“All patient rooms will be configured to provide dedicated space for our patients, providers and families,” said CareFirst Clinical Senior Project Manager Maria Happe. “Providing a dedicated family space within the intensive care rooms helps to promote and enhance family engagement and patient and family-centered care for our most critically ill patients.”
Family advisors like Ed Wolff and his wife, whose daughter spent five and a half months in the NICU at Texas Children’s in 2004 followed by three and a half months in the CVICU, were key partners in the simulations. They shared valuable perspectives on how to customize the new space to fit the unique needs of patients and families in a critical care environment.
“These new rooms will bring family-centered care to the next level,” Wolff said. “A nurse may be with your child for 12 hours, and they see a lot, but the parents are there 24 hours a day during shift changes. By adding a family space, parents can be at the bedside with their critically ill child and can easily observe the monitors from the family space, which I think in the end, will lead to even better outcomes.”
Dr. Patricia Bastero, a pediatric intensive care physician and associate director of ECMO at Texas Children’s Heart Center, says these collaborations reflect our unwavering commitment to patient care.
“Building a simulated hospital to test all possible scenarios in real life, discard all the bad options and come up with the best solutions exemplifies our passion for what we do,” Bastero said. “This was a team effort on many different levels to ensure a safe environment of care is cultivated for our critically ill patients and their families.”