Translational work integrating simulation and systems testing

Introduction: The pediatric intensive care unit, where the majority of in-hospital cardiac arrests occur, in an inherently chaotic environment. Resuscitation ergonomics improves patient outcomes by optimizing the interaction of the environment with human factor driven behaviors. “Room Diagramming” is a risk mitigation strategy that provides strategic mapping for personnel and equipment to optimize CPR quality and improve resuscitation efforts. Translational Work Integrating Simulation and Systems Testing (TWISST) was implemented to identify barriers to optimal resuscitation ergonomics and create a room diagram that effectively integrated into workflow. Methods: In 2021, TWISST was conducted. This approach included Simulation-based Clinical Systems Testing, simulated scenarios of cardiac arrest events, SAFEE debriefing, and Failure Mode and Effect Analysis (FMEA). System improvements were then embedded in a simulation-based education initiative. Results: In iterative cycles of process improvement, strategic mapping of personnel and equipment to improve resuscitation ergonomics was developed. Inefficient supply allocation and team member positioning were identified as key areas that impacted team member communication, CPR orchestration and quality. Room diagraming defined BLS team member positioning (Chest compressor, RN, RT), location of defibrillator, “Doc Squad” positioning (Physician Team Lead, RN Documenter, Defibrillator provider/CPR coach), and a medication preparation area. Addition of a pharmacy cart, defibrillator cart, and medication tray were identified as resources to optimize ergonomics and workflow. These elements were then embedded into a simulation-based team training education initiative. Conclusions: TWISST applied to cardiac arrest events explored work system and process inefficiencies in resuscitation ergonomics and room diagraming. In iterative PDSA cycles, teams identified latent conditions, tested potential solutions, and devised a room diagram that integrated into workflow and culture and considered our ICU room layout. Evaluating systems of care during resuscitation, embedding and testing solutions into bedside practice ensured optimal integration into clinical workflow prior to widespread implementation.