Transportable enhanced simulation technologies for pre-implementation limited operations testing: neonatal intensive care unit.

Introduction: Transition of a Neonatal Intensive Care Unit (NICU) to a new physical plant incurs many challenges. These are amplified when the culture of care is changing from traditional cohort-based care to the single-family room model. Altered healthcare delivery systems can be tested in situ with TESTPILOT: Transportable Enhanced Simulation Technologies for Pre-Implementation Limited Operations Testing. The aims of the study included promoting translation of existing processes and identifying staff orientation material. We hypothesized that (1) numerous process gaps would be discovered and resolved, and (2) participants would feel better prepared.

Methods: A functional neonatal intensive care unit was modeled before its opening. Scenarios were developed, volunteers recruited, and rooms supplied with equipment. Participants performed usual duties in two 30-minute in situ simulations followed by facilitated debriefings. As latent safety hazards were identified, they were corrected and retested in subsequent simulations. Staff was surveyed for perceived preparedness.

Results: Ninety-six multidisciplinary participants identified 164 latent safety hazards in verbal and written communication, facilities, supplies, staffing, and training, 93% of which were resolved at transition. Staff preparedness varied but showed improving communication, workflow patterns, and awareness of equipment and supply locations. The majority stated that this simulation experience changed their practice.

Conclusions: Simulation is very effective for identifying process gaps before major institutional change. TESTPILOT generated iterative workflow enhancements and staff orientation toward improving patient care at transition and beyond. The extensive coordination required to implement such large-scale simulations is well worth the benefit for systems refinement and patient safety.