Simulation-based Framework to Improve Patient Experience in an Emergency Department

The global economic crisis has a significant impact on healthcare resource provision worldwide. The management of limited healthcare resources is further challenged by the high level of uncertainty in demand, which can lead to unbalanced utilisation of the available resources and a potential deterioration of patient satisfaction in terms of longer waiting times and perceived reduced quality of services. Therefore, healthcare managers require timely and accurate tools to optimise resource utility in a complex and ever-changing patient care process. An interactive simulation-based decision support framework is presented in this paper for healthcare process improvement. Complexity and different levels of variability within the process are incorporated into the process modelling phase, followed by developing a simulation model to examine the impact of potential alternatives. As a performance management tool, balanced scorecard (BSC) is incorporated within the framework to support continual and sustainable improvement by using strategic-linked performance measures and actions. These actions are evaluated by the simulation model developed, whilst the trade-off between objectives, though somewhat conflicting, is analysed by a preference model. The preference model is designed in an interactive and iterative process considering decision makers preferences regarding the selected key performance indicators (KPIs). A detailed implementation of the framework is demonstrated on an emergency department (ED) of an adult teaching hospital in north Dublin, Ireland. The results show that the unblocking of ED outflows by in-patient bed management is more effective than increasing only the ED physical capacity or the ED workforce

Virtual ED: Utilisation of a Discrete Event Simulation-Based Framework in Identifying Real-Time’ Strategies to Improve Patient Experience Times in an Emergency Department

Objectives and Backgrounds Emergency Department (ED) overcrowding and associated excessive Patient Experience Times (PETs) have proven deleterious impacts on patient mortality, morbidity and overall length of hospital stay. Health systems constantly seek cost-effective organisational strategies to reduce ED crowding and improve patient outcomes, but complex change implementation is constrained by the necessity of maintaining concurrent safe patient-care. Computer modelling in a “virtual reality” has been successfully utilised in industries outside medicine, in providing innovative “real-time” solutions to outdated practices. Therefore a bespoke “Virtual ED” computer model, based on a Discrete Event Simulation (DES) -Based Framework was constructed to determine the best simulation scenarios needed for effective “real-time” strategies to improve PETs in a Dublin teaching hospital ED. The three simulation scenarios tested were: (1) Increasing medical staffing. (2) Increasing assessment space. (3) Enforcing the national 6-h boarding limit. Methods A collaborative interactive decision support model was constructed to analyse patient flow through the ED, considering the variability in patients\u27 arrival rate, the complexity levels of patients\u27 acuity, and the dynamic interactions between key resources (eg, clinical staffing, physical capacity, and spatial relationships). ED Process Mapping utilised IDEF0, for modelling complex systems in a hierarchical form and Extend Suite V.7 software was used to develop the DES—based framework model. Historical, anonymised ED patient data of 59 986 patient episodes (tracking times, indirect acuity and clinical resource utilisation) was analysed from the “real-time” ED Information System. Baseline ED Key Performance Indicators (KPIs), PETS and resource utilisation was determined for comparison with the DES model. Distinct study scenario variables (Abstract 007 table 1) were added to the DES model and run for 3 month continuous blocks to eliminate confounders. Continuous verification and validation of the ED simulation model was ensured by using Kolmogorov–Smirnov goodness of fit test with a 5% significance level. The ultimate results of the simulation model were validated using three techniques; face validation, comparison testing, and hypothesis testing, with the deviation between actual and simulated results ranging from 1% to 9% with an average of only 5% deviation

Implementation of TeamSTEPPS

This scholarly project focused on implementing Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) in an emergency room (ER). The aim of TeamSTEPPS is to improve patient outcomes by educating healthcare professionals on communication and teamwork skills. TeamSTEPPS teaches healthcare professionals leadership skills, shared mental models, mutual trust, and closed loop communication. The purpose of the scholarly project was to improve teamwork and communication. The study method was descriptive analysis of 51 pre and posttest questionnaires, specifically looking for increased knowledge of TeamSTEPPS tools. The participants included: ER physicians, ER nurses, ER certified nursing assistants/health unit coordinators, a pharmacy technician, public safety officers, and patient revenue management organization (PRMO). Further research is needed to evaluate how to significantly increase staff knowledge on TeamSTEPPS tools in a class setting

Inter-professional in-situ simulated team and resuscitation training for patient safety: Description and impact of a programmatic approach

© 2015 Zimmermann et al.Background: Inter-professional teamwork is key for patient safety and team training is an effective strategy to improve patient outcome. In-situ simulation is a relatively new strategy with emerging efficacy, but best practices for the design, delivery and implementation have yet to be evaluated. Our aim is to describe and evaluate the implementation of an inter-professional in-situ simulated team and resuscitation training in a teaching hospital with a programmatic approach. Methods: We designed and implemented a team and resuscitation training program according to Kerns six steps approach for curriculum development. General and specific needs assessments were conducted as independent cross-sectional surveys. Teamwork, technical skills and detection of latent safety threats were defined as specific objectives. Inter-professional in-situ simulation was used as educational strategy. The training was embedded within the workdays of participants and implemented in our highest acuity wards (emergency department, intensive care unit, intermediate care unit). Self-perceived impact and self-efficacy were sampled with an anonymous evaluation questionnaire after every simulated training session. Assessment of team performance was done with the team-based self-assessment tool TeamMonitor applying Van der Vleutens conceptual framework of longitudinal evaluation after experienced real events. Latent safety threats were reported during training sessions and after experienced real events. Results: The general and specific needs assessments clearly identified the problems, revealed specific training needs and assisted with stakeholder engagement. Ninety-five interdisciplinary staff members of the Childrens Hospital participated in 20 in-situ simulated training sessions within 2 years. Participant feedback showed a high effect and acceptance of training with reference to self-perceived impact and self-efficacy. Thirty-five team members experiencing 8 real critical events assessed team performance with TeamMonitor. Team performance assessment with TeamMonitor was feasible and identified specific areas to target future team training sessions. Training sessions as well as experienced real events revealed important latent safety threats that directed system changes. Conclusions: The programmatic approach of Kerns six steps for curriculum development helped to overcome barriers of design, implementation and assessment of an in-situ team and resuscitation training program. This approach may help improve effectiveness and impact of an in-situ simulated training program

Teaching the Emergency Department Patient Experience: Needs Assessment from the CORD-EM Task Force.

INTRODUCTION: Since the creation of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction (PS) scores, patient experience (PE) has become a metric that can profoundly affect the fiscal balance of hospital systems, reputation of entire departments and welfare of individual physicians. While government and hospital mandates demonstrate the prominence of PE as a quality measure, no such mandate exists for its education. The objective of this study was to determine the education and evaluation landscape for PE in categorical emergency medicine (EM) residencies. METHODS: This was a prospective survey analysis of the Council of Emergency Medicine Residency Directors (CORD) membership. Program directors (PDs), assistant PDs and core faculty who are part of the CORD listserv were sent an email link to a brief, anonymous electronic survey. Respondents were asked their position in the residency, the name of their department, and questions regarding the presence and types of PS evaluative data and PE education they provide. RESULTS: We obtained 168 responses from 139 individual residencies, representing 72% of all categorical EM residencies. This survey found that only 27% of responding residencies provide PS data to their residents. Of those programs, 61% offer simulation scores, 39% provide third-party attending data on cases with resident participation, 37% provide third-party acquired data specifically about residents and 37% provide internally acquired quantitative data. Only 35% of residencies reported having any organized PE curricula. Of the programs that provide an organized PE curriculum, most offer multiple modalities; 96% provide didactic lectures, 49% small group sessions, 47% simulation sessions and 27% specifically use standardized patient encounters in their simulation sessions. CONCLUSION: The majority of categorical EM residencies do not provide either PS data or any organized PE curriculum. Those that do use a heterogeneous set of data collection modalities and educational techniques. American Osteopathic Association and Accreditation Council for Graduate Medical Education residencies show no significant differences in their resident PS data provision or formal curricula. Further work is needed to improve education given the high stakes of PS scores in the emergency physician\u27s career

Improving Emergency Response in the Outpatient Clinic Setting

Background: Effective triage, assessment, and activation of necessary systems in emergent situations of clinical instability is vital in reducing morbidity and mortality of patients in any clinical setting. When medical emergencies occur outside of the hospital, organized and expedited transfer to a higher level of care reduces the potential for adverse events, lasting deficits, and patient death. Aim: The aim of this project was to identify weaknesses in the emergency response system in the community-based outpatient clinic setting and to propose solutions. Methods: The “Swiss Cheese” theoretical framework was used to do a root cause analysis of two clinical scenarios. Weaknesses in the emergency response system in the community-based outpatient clinic setting were identified. Results: Several tools were utilized including a fish bone diagram and the 5-Whys tool. Two root causes were identified. The first is that clinic staff does not have a working knowledge with specifics regarding the emergency response process. The second is that the existing emergency response checklist document is visually confusing and duties are not in sequence. Discussion and Implications for the CNL: Weaknesses in the emergency response system will be discussed. Knowledge and experience from inpatient care will be translated to the outpatient clinic setting. The role of the CNL in designing an effective emergency response system will be discussed with the proposal of several plans of action

Committed to Safety: Ten Case Studies on Reducing Harm to Patients

Presents case studies of healthcare organizations, clinical teams, and learning collaborations to illustrate successful innovations for improving patient safety nationwide. Includes actions taken, results achieved, lessons learned, and recommendations