Prevention of Latent Safety Threats: A Quality Improvement Project to Mobilize a Portable CT

Abstract

Introduction: Transporting critically ill patients to diagnostic imaging for needed studies can be challenging and even prohibitive. A portable computerized tomography (CT) scanner allows the patient to remain in the intensive care unit, but presents new positioning and team challenges. Before activation of a portable CT scanner in our pediatric intensive care unit and through the use of iterative simulation-based Plan-Do-Study-Act (PDSA) cycles in the clinical environment, a multidisciplinary team of bedside caregivers determined optimal patient positioning, equipment needs, and specific staffing and choreography to develop detailed portable CT guidelines. Method: Our team engaged stakeholders from radiology, critical care, respiratory therapy, environmental services, facilities operations, and the CT vendor to develop scenarios. Simulations included infant and pediatric patients who required critical invasive monitoring and treatment devices, such as ventilators, and high-risk intracardiac and intravascular lines. Scenario objectives centered on the safe positioning, transfer, and scanning of the patient. Trained simulation specialists from the hospital’s simulation center facilitated simulation sessions. Results: Simulation-based PDSA testing identified 31 latent safety threats, including the need for a custom bed adapter due to pediatric patients’ variable size. We paused portable CT activation pending the custom adapter’s availability and remediation of other latent safety threats. Additional simulation-based PDSA cycles further refined the process once the custom adapter was available. Conclusions: Simulation identified unanticipated latent safety threats before the implementation of a portable CT scanner.

Recent technologies in cardiac imaging

“…Clinical CTs can wildly differentiate in weight due to the diverse selection on the market. Portable CT scanners can weigh as light as 500 pounds, and clinical stationary CTs may weigh several thousands of pounds ( 78 ). Patients are typically more comfortable in a CT scanner than in an MRI due to shorter scans, less noise, and it is not as small or claustrophobic ( 79 ).…”

Let us to the TWISST; Plan, Simulate, Study and Act

“…[5][6][7][8] At our institution, the novel application of simulation augments how we reliably identify LSTs, understand system failures, and eliminate, facilitate, or mitigate errors in our system. 1,7,9,10 When implementing lean strategies to reduce waste, improve safety, and augment workflow, these initiatives often fail to integrate as intended due to unexpected barriers in local microsystem work culture, workflow, or bedside practice. 11 Failure to implement sustainable solutions results in wasted resources, recurrent errors, development of workarounds, and drift from best practice.…”

“…Like the quality-based method of assessing change, Plan-Simulate-Study-Act (PSSA) is a problem-solving method to identify key drivers for process improvements. 10 , 13 This method specifies simulation as the iterative process improvement tool. High-fidelity simulations conducted in TWISST recreate and approximate the realities of complex patient care delivery to demonstrate work-as-done, unpacking the dynamic interaction of people with their work system.…”