Latent Safety Threats in the PICU: Finding the Unseen*

LaRosa, Jessica; Xie, Anping; Fackler, James C.

doi:10.1097/pcc.0000000000002863

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…Patient safety is an enormously important area of healthcare research (26) that has received increased attention since the 2000 report of the Institute of Medicine, To Err Is Human, was published (27). In the current study, we have used high-fidelity simulations in the new environment before moving to a new ICU to identify possible issues in order to address them before endangering real patients.…”

Section: Discussionmentioning

confidence: 99%

Video-Recorded In Situ Simulation Before Moving to the New Combined Neonatal/Pediatric Intensive Care Facility: An Observational Study

Krammer

Kessler

Aspalter

et al. 2022

Pediatric Critical Care Medicine

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Moving an ICU to a new location is a challenge. The objective of this study was to use in situ simulation to identify potential problems and solutions with the new environment before commencing patient care.DESIGN: Planned, observational video-recorded simulation study using four scenarios: delivery room management of term-neonate; delivery room management of extremely low-birth-weight infant; management and transfer of an infant with respiratory syncytial virus bronchiolitis and apnea; and management and transfer of an adolescent with septic shock. SETTING: Academic tertiary neonatal and combined neonatal ICU/PICU. PARTICIPANTS: Sixteen volunteers (eight physicians, eight nurses). INTERVENTIONS:Standardized briefing introduction, with before versus after survey of thoughts about each scenario, and after 8 weeks, debriefing at least 60 minutes and additional video recording. MEASUREMENTS AND MAIN RESULTS:A total of 91 potential problem areas were identified and included issues related to technical aspects (n = 29), infrastructure (n = 27), administration (n = 19), and structure (n = 16). Fifty-three (58%) of these potential issues could be resolved before the move, including: 15 of 29 technical, 15 of 27 infrastructure, nine of 19 administration, and 14 of 16 structural. The video analysis revealed an additional 13 problem areas (six technical, three infrastructure, two administration, and two structural). Participants felt more confident 8 weeks after the simulations (χ 2 = 12.125; p < 0.002). All 16 participants confirmed the usefulness of the in situ simulation, the majority wanted further introductions to the new ward (n = 13) and noted a positive impact of the changes on the new ward (n = 12). CONCLUSIONS:In situ simulation before moving into a new facility identifies numerousness potential problem areas. Survey shows that providers feel better prepared and are more confident. Video recording reveals additional difficulties not addressed in conventional verbal debriefing. KEY WORDS: improvement; in situ simulation; new facility; quality of care; video recording M oving a combined neonatal ICU/PICU to a new location, with twice the capacity, is a challenge for the staff. Despite precise planning, deficits and possible options for improvement only become apparent when the new ward is put into operation. This is accompanied by a considerable safety risk for patients (1, 2). When establishing or restructuring a new ward, it is essential to achieve full functionality by optimizing infrastructure and work processes (1, 3).

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Section: Discussionmentioning

confidence: 99%

Video-Recorded In Situ Simulation Before Moving to the New Combined Neonatal/Pediatric Intensive Care Facility: An Observational Study

Krammer

Kessler

Aspalter

et al. 2022

Pediatric Critical Care Medicine

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“…Of key interest were those latent threats that occurred when staff were complying with policies and protocols. Our editorial takes up this theme and discusses the next logical iteration in human factors research using such observational data (2).…”

Section: What Are the “Human Factors-related” Latent Threats To Safet...mentioning

confidence: 99%

Editor’s Choice Articles for March

Tasker¹

2022

Pediatric Critical Care Medicine

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“…A major reason is that mortality has declined significantly since the 1980s (5, 6). Derivative scores were designed to identify severity associated morbidities (7) but not to identify latent safety threats (8) or to specifically risk stratify an individual complex patient. In this issue of Pediatric Critical Care Medicine , Verlaat et al (9) provide a concrete example; digging one layer deeper they discovered worrisome patterns of potentially preventable safety issues associated with new morbidities.…”

mentioning

confidence: 99%

Data, Anomalies; a Call to Cease and Desist*

Pittman

Bernier²,

Fackler³

2023

Pediatric Critical Care Medicine

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Children with special healthcare needs, children with complex chronic conditions, children with medical complexity-a syndrome with several names, is an expanding patient population and represents an increasing number of inpatient admissions and healthcare expenditures (1, 2). As their overall inpatient admissions increase, so too do these children represent an increasing proportion of PICU admissions (3). Said differently, the PICU of 2023 is quite different than the PICU your grandparents knew in 1980. Many of the techniques and workflows of the 80s are now irrelevant or counterproductive.For example, a routinely used severity of illness scoring system (i.e., Pediatric Risk of Mortality [PRISM] [4]) was developed in the 80s and while updates are done periodically, there are many reasons these systems should be revamped. A major reason is that mortality has declined significantly since the 1980s (5, 6). Derivative scores were designed to identify severity associated morbidities (7) but not to identify latent safety threats (8) or to specifically risk stratify an individual complex patient. In this issue of Pediatric Critical Care Medicine, Verlaat et al (9) provide a concrete example; digging one layer deeper they discovered worrisome patterns of potentially preventable safety issues associated with new morbidities.As PICU lengths of stays push well into double and even triple-digit days, often within a subpopulation of children who simply cannot be cared for outside of the critical care setting, severity of illness scores at the time of admission predict little of what is to come. While outcomes in aggregate may improve with the use of such systems (10), it behooves us who care for these children with medical complexity to ensure we equitably recognize and address the potentially unique safety challenges this population presents.The study by Verlaat et al ( 9) explores the role adverse events may play in mortality among patients stratified as low risk for mortality at the time of their PICU admission. These "low-risk non-survivors" have a higher occurrence of adverse events than their counterparts who survived. Strikingly, this cohort of patients identified as low-risk are overwhelmingly patients with underlying complex chronic conditions-93% of low-risk nonsurvivors fall into this category. Their length of stay was considerably longer, more needed mechanical ventilation, and their duration of ventilation was longer than their low-risk surviving counterparts. This group of patients begs two important questions: do we underestimate the risk of mortality in children of medical complexity, and do we underrecognize important safety threats in this population? Or as Eulmesekian (11) commented on this group's earlier work (12), "Nevertheless, the article leaves readers with a clear message, which, while not new, is relevant: low-risk patients with [chronic critical conditions] are frequent PICU flyers, they may get worse, they may need intubation, they may die, and as we are not

show abstract

Latent Safety Threats in the PICU: Finding the Unseen*

Cited by 3 publications

References 13 publications

Video-Recorded In Situ Simulation Before Moving to the New Combined Neonatal/Pediatric Intensive Care Facility: An Observational Study

Video-Recorded In Situ Simulation Before Moving to the New Combined Neonatal/Pediatric Intensive Care Facility: An Observational Study

Editor’s Choice Articles for March

Data, Anomalies; a Call to Cease and Desist*

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