Healthcare Design - November 2019 - 72

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T E S T P R E PA R AT I O N

Children's Healthcare of Atlanta implemented SbCST at 15 clinics
within its Center for Advanced Pediatrics in Atlanta, a tertiary outpatient pediatric subspecialty center. The process for one of those clinics, the pediatric allergy clinic, required a collaborative approach that
included clinic stakeholders (administrative, operational, and clinical
leaders; educators; nursing and physician division directors), frontline
staff (physicians, nurses, and medical assistants), and simulationists
(clinicians within the healthcare institution who deliver simulationbased programs).
Three months prior to testing, members of the simulation team met
with administrative leaders from the allergy clinic to identify routine
episodes of care and potential emergency situations. Concerns related
to the new clinic's physical layout, processes and procedures, new technologies, and supply and equipment storage were identified. From this
information, the simulation team outlined the clinical context for testing, and two clinical scenarios were created: (1) a routine visit for allergy testing where the patient developed anaphylaxis but recovered
and (2) an emergency event where the patient developed anaphylaxis
and required treatment and transfer to the hospital. Process maps were
created in order to detail how the patient would flow through the clinic;
tasks that would be conducted during these care episodes; all necessary
equipment, supplies, and medications needed; and specific roles of each
team member.
The process map ensured that scenarios met specific testing objectives
such as evaluation of overall design, patient safety, infection control,
workflow efficiency, and patient and family experience. For example, clinicians evaluated the overall design of the patient exam room, accessibility of fixed design elements such as the sharps container (staff safety),
location of hand foam (infection control), use of tracking board technology (workflow efficiency), location of code carts, and the process related
to the management of anaphylaxis (patient safety).

72

NOVEMBER 2019

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HCD EXPO
To hear more
on the use of
SbCST and how
it was applied at
Children's Healthcare of Atlanta, join
the authors during
the session "E13 Designing for Patient
Safety: Use of Simulation to Detect Latent
Safety Threats Prior
to Patient Exposure"
at the HCD Expo &
Conference, Nov.
2-5 in New Orleans.
Visit HCDexpo.
com for conference
information and to
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A one-day test was conducted in September
2018, a month prior to the clinic opening, and
included clinicians who would be transitioning into the new space and stakeholders from
the collaborative working group to observe the
simulations. Each scenario lasted 20 minutes
and was followed by an immediate debriefing to
conduct the risk assessment where teams could
identify workflow inefficiencies, threats to patient or staff safety, accessibility to emergency
supplies, functionality of fixture placement,
adaptability to varying patient care needs, or
gaps in process.
Multiple LSTs related to fixture placement
were identified during the routine allergy visit
scenario. For example, the sharps container
was too close to the patient exam table, putting patients at risk if they stuck their hands in
the box. The mounted otoscope was centered
above the patient exam table and difficult for
providers to reach. The lack of a hand foam
dispenser outside each patient exam room
didn't support hand hygiene compliance. Clinicians also noted the wayfinding signage was
confusing for parents who were trying to exit
the clinic. In the second scenario, clinicians
identified a lack of knowledge regarding what
supplies were stored in the code cart, inconsistent use of tracking boards that made it
difficult for team members to know where a
physician was during an emergency, and a gap
in knowledge regarding the role of the emer-
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Healthcare Design - November 2019

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