By Ted Napolitano, SimLEARN Field Activity Project Manager
The new Orlando VA Medical Center currently undergoing simulation evaluations. (VA photo by Reginald Kornegay)

The new Orlando VA Medical Center currently undergoing simulation evaluations. (VA photo by Reginald Kornegay)

In 2012, a SimLEARN hospital activations team led by Dr. Haru Okuda, SimLEARN’s national medical director, began traveling to new VA medical centers (VAMC) to work with local staff to rehearse patient flow and test hospital systems for unanticipated events or situations.

Having previously conducted evaluations at the new VAMC in Las Vegas, the team is currently involved in the activation of outpatient clinics in the new Orlando VAMC at Lake Nona, Florida.

In performing these evaluations, the SimLEARN team applies simulation technology to tackle one of the greatest challenges facing medical practitioners and hospital risk managers which is to identify previously unknown clinical issues as VA “stands up” replacement hospitals.

The problem of identifying unknown issues is complicated by several factors: current teams can be broken up and reorganized with new employees; everyone is working in unfamiliar, new facilities; the equipment and technologies are new or upgraded; and new health care services are offered, often requiring new therapies.

The team begins the process with leadership briefings about the strategy and interviews with clinical subject-matter experts to learn of potential issues. SimLEARN develops scenarios to evaluate patient flow, work flow and equipment, and then conducts the simulation of patient processing with team members and clinic supervisors capturing information about issues that arise. The information is reviewed by SimLEARN’s team, which completes a failure mode and effects analysis to determine the severity, probability and potential risks. This process is completed and results are briefed to hospital leadership weeks before the doors are opened to new clinic patients, with the goal of the framework to identify and mitigate issues before patients come in for treatment.

At the 1.2 million-square-foot Orlando VAMC, the SimLEARN team has conducted activation simulations for the primary care, dental, audio and speech pathology, eye, mental health, physical medicine and rehabilitation clinics, as well as the Canteen. Yet, there are more activation simulations to come, including surgery, the emergency room and inpatient care during the multi-phase approach of bringing the large facility on-line.

The clinic staff involved in these simulations reported in a survey that they saw how simulation testing improved workflow and patient flow issues. The graphic (right) illustrates they also would use it again.

In addition, a standardized patient care improvement (PCI) matrix designed to identify the PCI probability and opportunity levels was used. The findings from the simulations are scored from “likely to occur immediately” down to “unlikely to occur and would not affect patient care.” The report to leadership includes the issues, matrix scores and recommendations to mitigate the issues.

As VA continues to improve facilities to care for America’s Veterans, SimLEARN’s hospital activation team plans to be there to help continue the effort to improve patient safety in patient care.