Emergency Response Preparation in a New Outpatient Proton Center

Abstract

Patient acuity is increasing in the ambulatory setting. New treatments and techniques assist patients in living longer, in turn allowing additional comorbidities to develop. Many of these comorbidities may require urgent treatment. Emergency response preparation can have a positive impact on readiness and timed responses to prevent and respond to emergencies. A new 80,000 square-foot ambulatory proton center was built within an academically-aligned community hospital. As part of its opening, protocols for emergency response preparation were developed and enacted. The aim of this Quality Improvement project was to develop a plan for emergency response as it pertains to declining patients and medical codes in a newly-opened ambulatory radiation oncology setting. Emergency response plans were developed in collaboration with the Armstrong Institute using the Systems Engineering Initiative for Patient Safety model (SEIPS) model to guide practice. The SEIPS model provides guidance when analyzing factors that affect patient safety. The focus of the plan was to identify potential risks and mitigate them in order to minimize adverse safety events for patients. Additionally, the plan was designed to allow for process improvement to improve quality and patient outcomes. The response plan was tested with three simulated scenarios: rapid response to a patient fall, pediatric cardiac arrest, and a medical emergency during an MRI procedure. Due to the scope of the exercise, only the pediatric cardiac arrest was trialed more than once. For the patient fall scenario, a hospital wide alert was dispatched in 25 seconds for the response team. The first rapid responder arrived within 85 seconds and the stretcher was brought to the scene in an additional 90 seconds. During the MRI scenario, staff were able to reduce the time to move the patient from 64 to 42 seconds. In the pediatric cardiac arrest scenario, there were decreases in time for staff arrival, arrival of an emergency cart, defibrillation, stretcher arrival, and transport to an appropriate level of care. Overall practice gaps identified include issues with the automated communications, and the need for ergonomic techniques for moving heavy equipment, an MRI stretcher, lighting in stairwells, and badge access. This quality improvement project utilized scenarios to facilitate identification of gaps in practice. Common themes amongst the scenarios were identified, and team members from various disciplines were able to work together to identify solutions to close the gaps. When opening a new outpatient clinical site, it is important to identify and test emergency response plans in order to promote patient safety.