29 Reducing Risk: Simulation-Based Clinical Systems Testing to Determine New Hospital Readiness for Anaesthesia Services

Abstract

The newly built Women’s Wellness and Research Center (WWRC) replaced the pre-existing Women’s Hospital (WH) as the only provider of tertiary maternity care for the residents of Qatar. The pre-existing WH was smaller, with a 12-bay emergency department, 3 operating theatres, 12 delivery rooms and 220 beds, in shared rooms. The new WWRC facility is significantly bigger, with a 28-bay emergency department, 7 operating theatres over two floors, 26 delivery rooms and 240 private inpatient rooms catering for around 18,000 deliveries per year. New systems, designed over only a few months, would need to promote that same level of high-quality patient care but in a newer, larger and unfamiliar facility.The aim of the study was to identify and mitigate clinical systems risks, relevant to anaesthesia services, by running The ‘WWRC Anesthesia Activation Team’ was established to conduct Approximately 110 hours of simulation were conducted in sites relevant to anaesthesia. Many of the participants had never experienced simulation before but nearly everybody complimented its usefulness and debriefing was unanimously constructive. Testing identified 143 discrete latent safety threats (LST) and were categorized under Facility, Workflow, Personnel, Process, Equipment and Technology (Table 1). Fifty-four LSTs were due to systems that were incomplete at the time of testing but would be completed by the time services commenced. The remaining 89 were significant LSTs which could have resulted in significant clinical incidents. After mitigation of LSTs, the areas were simulation tested again to confirm threat elimination. WWRC was opened only after all areas of concern were addressed. A year after moving, a review of all the changes recommended from the simulation-based systems testing was conducted. It showed that there were no anaesthesia-related clinical incidents in those areas.Our experience confirms that simulation can identify Latent Safety Threats (LST) prior to a major move to a new facility