Healthcare Design - April 2014 - 46

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facility, confidentiality and privacy for patients and
caregivers, and overall safety.
Providers
Orientation, scavenger hunts, and equipment training have all been reliable tools in the "occupancy
toolbox" of new hospitals and continue to be of
substantive value. Clinical operations commissioning provides the next level of provider readiness by integrating all of the functions needed
for patient care and testing them simultaneously.
One of the most crucial areas to test is the communication systems. Most often, new facilities
have installed systems with which staff have little
or no familiarity. These systems are often serially
integrated so that one system (e.g., equipment
alarms) notifies a second or even a third system,
such as nurse call or the phone system. These
interconnected systems need to be carefully
tested with as many staff members as possible
during the simulations. Too often, this is a major
area of vulnerability during early occupancy in a
new facility.
Although physicians are critical to the success
of a new facility, they often inadvertently become
one of the biggest challenges for successful
preparation. By incorporating a focus on physicians' critical functions during the simulations,
such as the ability to navigate appropriate and
timely access routes during code situations, an
organization can substantially reduce the time
needed for physician training. Scheduling short,
intense drills and offering multiple times for physician involvement will help bring physicians into
the equation.
Also, too often, attempts at "day in the life"
drills focus exclusively on daytime operating
hours. It's recommended that scenarios be developed that test staffing and processes around the
clock. As an example, one organization learned
only through simulation that it had neglected to
provide an administrative point person for evenings and nights who could coordinate functions
during codes or crises.
Visitors and families
With so much focus put on designing new
processes for patients and providers, a very common oversight is the flow of families and visitors
through a new facility. Issues such as the locations to which families are directed during crisis
moments in the emergency department, or how
wayfinding instructions will be delivered by staff,
all must be identified prior to the occupancy of a
new building. Simulations offer the opportunity
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to include "mock" family members who might be
assigned to act as if they are angry, frightened, or
just plain bothersome. Insights gained from each
of these types of scenarios can help prepare for a
smoother transition.

"Day in the life" drills shouldn't focus
exclusively on daytime operating hours.
Instead, develop scenarios that test staffing
and processes around the clock.
Supplies
While scavenger hunts are wonderful introductions for orienting staff to the location of supplies,
simulations can help the organization take that
next step toward preparing for how those supplies
will actually be utilized in patient care areas. Critical issues, such as where kits are opened, how
their disposal is accommodated, and how asepsis
or sterility is managed in patient care areas, can
all be integrated into simulations for new or nonstandard supplies.
Equipment
For staff members working in an OR, for example,
concern is already focused on supporting a critical
surgical procedure, such as neurosurgery; but
when a new space like a hybrid OR comes on
line, the situation becomes even more complex.
Now, a sterile field must be maintained as the
CT or MRI moves in and out of the surgical suite.
Add to those concerns the numerous safety
issues for nonferrous materials because of the
MRI. Think of all the scalpels, clamps, etc., that
need to be safely housed so they're not disrupted
when equipment is turned on. Having staff trained
not only on the new equipment itself but also on
exactly how to use it in a particular patient care
space-whether an OR, imaging area, or patient
room-is crucial to the safe delivery of care.
Developing code scenarios in patient rooms or
other likely places to test equipment accessibility,
staff movement, etc., is important for ensuring a
safe environment and boosting staff confidence.
In addition, as more and more facilities utilize
multiple moveable booms for monitors, gases,
power, and other critical supports, staff need to
be able to practice using these items in a variety
of challenging scenarios that create realistic
situations, so that patients and families can feel
confident of the staff's ability to navigate the new
environment safely. Another key safety concern

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Healthcare Design - April 2014

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