Systems Testing both a Hospital System AND a Simulation System


Blog post by SimGHOSTS MEA Officer Valen Anderson, Sidra Medical and Research Center, Doha Qatar

The Simulation Team at Sidra Medical and Research Center has a unique opportunity working at a brand-new, Greenfield hospital to use Simulation for every facet of the hospital’s ‘Systems Testing’. Over the last couple weeks, we have put both standardized patients, as well as patient simulators, through various systems in the hospital to test and review the operational readiness. This has been a very intriguing experience that I feel may be beneficial to share, for anyone at any hospital opening a new department, using a new EMR, or using new equipment. Systems Testing is a critical process to ensure operational readiness, especially in respect to quality and patient safety.

Two weeks ago, we Systems Tested two hospital clinics simultaneously (Dermatology and Pediatric Surgery). These are example of some of the processes we tested and reviewed during this process:

  • CERNER (EMR) integration
  • Patient transfer between departments (ie. Diagnostic Imaging, Phlebotomy)
  • Signage efficiency (ease of patient navigation)
  • Rapid Response Activation
  • Code Blue Activation
  • Adverse events (family member of a patient collapsing, upset parents, etc.)

What we also tested and reviewed, although not our primary aim, was our own Simulation Systems.

We had set-up four wireless SMOTS viewing stations on Day 1 of Systems Testing, in live-viewing rooms adjacent to the clinic rooms being tested. Participants ran through their processes in the clinic room while raters and reviewers watched and assessed them. Unfortunately once all the participants, the raters, and the reviewers arrived, most of whom had at least one cell phone, we lost all wireless connectivity. Luckily, in anticipation, we had several long reels of Ethernet cable to hardwire the system. However this resulted in us running around like chickens with our heads cut off trying to ensure we were ready to start on time. Our next issue was a human factors issue relating specifically to audio. The sound of people, on the sidelines and in the hallways, whispering during the scenario fed through the sensitive microphones and confused the sound for both the ‘live viewing’ and for the recording. Thankfully we were able to rectify this the second time around in our pre-brief, and emphasized the importance of minimizing background noise and conversations from anyone not directly participating in the scenario.

An interesting observation was that, although our Sim Team had many years of simulation experience, most of the clinical participants had very little. It seemed as if our pre-brief was information overload for many of them, and they were so nervous that they only retained a few key points. This was apparent in their background chatter, but more significantly in how they interacted with the simulated environment. We encountered the “imaginary oxygen” issue, where participants grabbed for an invisible oxygen mask (although the room was stocked with medical equipment and consumables) and placed it on the patient. Participants were then deciding what the improved oxygen saturation was, after administering their invisible oxygen. This flaw is pivotal. You cannot test a system without actually going through all the necessary processes within the system. This basic omission was again addressed in the pre-brief with hopes to improve the simulation.

As a Sim Team our hope and plan for Sidra is to create a culture of simulation; where the staff participate in simulation often enough to understand the basics: suspension of disbelief, do what you would normally do in your own practice, you will be filmed, this is a safe place, etc. I guess I was particularly surprised by the learning curve here… but I shouldn’t have been. The organization is staffed with over 40 nationalities, crossing countless cultures and speaking at least a dozen languages. Every team is diverse, including our own.

One solution the Sim Team have put forward to rectify this knowledge gap is to create an Introduction to Simulation eLearning Module that will be sent out to all participants as mandatory learning prior to under taking their first simulation session. Once participants have completed this eLearning they will be invited into an appropriate simulation scenario, were we will spend adequate time familiarizing them to the environment and the nature of simulation.

I hope to update you all with our progress here at Sidra in creating a culture of simulation whilst opening a new hospital.