OBJECTIVE We used simulation-based clinical systems testing (SbCST) to identify and mitigate latent safety threats (LSTs) before opening a large critical care building (CCB) at a pediatric institution. METHODS We completed an SbCST project to identify LSTs before opening a 7-floor, 319-bed CCB at a pediatric institution. The extensive preparation process included warehouse planning sessions and a formal intake process. A total of 20 care units/groups had at least one 3-hour in situ simulation session. Each simulation scenario lasted approximately 1 hour (20-minute simulation, 40-minute debriefing). Participants included clinical teams and unit stakeholders. Facilitators received SbCST training, led debriefing using a modified Promoting Excellence And Reflective Learning (PEARLS) format, and documented LSTs along with suggested mitigations. Unit/group stakeholders scored LSTs using failure modes and effect analysis (FMEA) and were responsible for completing mitigations. RESULTS We completed 128 of 141 (91%) scheduled sessions over a 9-week period. Across all sessions, 238 scenarios were completed. The mean number of scenarios was 2 per session and 12 per unit/care group. We identified 1500 LSTs; the median per scenario was 10 (IQR 7–15, range 0–54). FMEA scores were assigned to 1450 (97%) LSTs. Median FMEA was 8 (IQR 4–16); 76% of scores were low (16). Mitigations were suggested for 951 (63%) of LSTs. CONCLUSIONS Even at scale, SbCST is an effective tool for identifying LSTs. FMEA scoring and a categorization schema for mitigations enhanced SbCST. Although the scale of this project has limited generalizability, any application of this approach would likely enhance the safety of comparable clinical spaces.
Kerrey et al. (Fri,) studied this question.