Stress Testing the Cardiac Catheterization Laboratory: A Novel Use of In Situ Simulation to Identify and Mitigate Latent Safety Threats During Acute Airway Management.

Autor:	Jafri FN; From the White Plains Hospital (F.N.J., R.S, D.B, R.T, A.A, D.E, D.M, K.E, J.C, G.A, H.P), White Plains, NY; SUNY Downstate Medical Center (S.B), Brooklyn, NY; and Brigham and Women's Hospital (A.K), Boston, MA., Santana Felipes RC, Bliagos D, Torres RE, Bellido S, Arif A, Elwell D, Mirante D, Ellsworth K, Cardasis J, Anastasian G, Pinto H, Kochar A
Jazyk:	angličtina
Zdroj:	Simulation in healthcare : journal of the Society for Simulation in Healthcare [Simul Healthc] 2024 Apr 01; Vol. 19 (2), pp. 75-81. Date of Electronic Publication: 2023 Apr 21.
DOI:	10.1097/SIH.0000000000000725
Abstrakt:	Introduction: Although uncommon, cardiac arrests in the cardiac catheterization laboratory (CCL) are often catastrophic and likely to increase with rising case complexity. In situ simulation (ISS) has been used to identify latent safety threats (LSTs) in inpatient units but has not yet been studied in the CCL. Methods: Three Plan-Do-Study-Act (PDSA) cycles leveraging ISS were conducted focused on acute airway management. Data collected through debriefs focused on (1) airway management, (2) equipment availability, and (3) interdepartmental communication. The LSTs were subcategorized and plotted on the Survey Analysis for Evaluating Risk (SAFER)-Matrix. A SAFER score was calculated based on quantifying the likelihood of harm, scope, and the number of times a threat was identified during simulation. Time to definitive airway was collected as a secondary measure. Interventions were developed using cause and effect and driver diagrams between PDSA cycles. Results: Eleven total simulations through 3 PDSA cycles were conducted between January and December 2021 (5 in PDSA 1, 4 in PDSA 2, and 2 in PDSA 3). One hundred one LSTs were identified with 14 total subcategories. The mean SAFER score decreased from 5.37 in PDSA 1, to 2.96 in PDSA 2, and to 1.00 in PDSA 3. Bivariate regression analysis showed a decrease in SAFER score of 2.19 for every PDSA cycle ( P = 0.011). Ordinary least squares regression had a decrease of 1.65 in airway-related threats every PDSA cycle ( P < 0.01) as well as an increase in intubation time of 35.0 seconds for every 1-unit increase in communication threat identified ( P = 0.037). Conclusions: This study successfully leveraged ISS and existing quality improvement initiatives in the CCL, resulting in a decrease in airway-related threats as measured through simulation. Competing Interests: The authors declare no conflict of interest. (Copyright © 2023 Society for Simulation in Healthcare.)
Databáze:	MEDLINE
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