Abstract:

The interdisciplinary panel of speakers will discuss their experience of using system-focused simulation to test the quality and safety of a new and complex clinical care model, Hospital at Home, in the pre-implementation phase. Hospital at Home is an innovative care model providing hospital-level care in the patient’s home, which allows eligible patients to receive acute care and recover in the comfort of their homes. It entails many of the same care processes occurring in the brick and mortal hospital, including clinician visits, vital signs, lab and diagnostic studies, medications, auxiliary therapies, and meals. In essence, this entailed developing a new hospital system outside the hospital, inclusive of the workflows, communication patterns, information technology infrastructure and care processes. A large interdisciplinary effort was undertaken to delineate the processes and best workflows from entry into the program through discharge. Kaizen events, steering committee meetings, and patient-centered focus groups drove the creation of the standard work.

Upon creation of the standard work, several tabletop simulations were conducted to confirm the appropriate processes and personnel, and identify potential system stress-points. This was then followed by “Day in The Life” (DiTL) simulations that included realistic scenarios with simulated patients and were designed to (1) validate and test – equipment, communication, procedures, and workflows and (2) discover – latent safety threats, resolutions to issues, opportunities to optimize quality of care and patient safety. Simulations encompassed the Hospital at Home process by beginning with patient eligibility and consent, the hospital stay, transitioning to home, care at home as a Hospital at Home patient and lastly discharge. Each simulation had participants in-person and via Zoom with members from the full interprofessional team (e.g., nursing, physicians, pharmacists, social workers, home nursing) and the hospital system team (e.g., IT, supply chain, pharmacy, operational excellence, simulation). Throughout the phases of the Hospital at Home program, the teams participated in focused interval debriefs centered on the SEIPS 2.0 (Systems Engineering Initiative for Patient Safety) human factors framework. The debriefs culminated in approximately 120 opportunities for improvement that were then triaged by criticality and importance to be addressed longitudinally.

Following the simulated sessions, the clinical team was equipped with valuable insights that significantly improved readiness to enroll the first patient in the Hospital at Home program. The team analyzed the outcomes, feedback, and learning points from the simulations and promptly integrated them into protocols and procedures. This involved refining the patient enrollment approach, fine-tuning equipment use, honing emergency response protocols, and enhancing interpersonal communication strategies to ensure a patient-centric approach. By learning from the simulated experiences, the team created a more robust and effective system, significantly reducing the potential for errors or mishaps. As a result, the team members were more confident in their ability to provide acute hospital-level care at home and better prepared to meet the unique needs and preferences of the first patient in the program. This iterative learning process ultimately elevated the standard of care provided, optimizing the patient experience from the get-go.

Learning Objectives:

1. Characterize the integration of simulation into a multidisciplinary effort for the development of a new clinical care model.
2. Describe the collaborative use of simulation and operational excellence programs in the pre-implementation testing of the new Hospital at Home program.
3. Demonstrate the impact of using the collective approaches of systems-focused simulation and operational excellence on process design and improvement, patient safety, and care delivery for new clinical models