SimLEARN Systems/Hospital activation on the move - VHA SimLEARN
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SimLEARN Systems/Hospital activation on the move

By Jane Robinson, MSN, RN, CEN
Systems/Hospital Activation Nurse
Simulation Outreach Network
VHA SimLEARN National Simulation Center

ORLANDO, Fla. – Opening a new clinical facility, renovating an existing space, or offering new clinical services comes with many potential hazards associated with the introduction of new processes and equipment, such as staff new to Veterans Affairs (VA), and/or new to the clinical locations; and the availability of resources. Process-oriented simulation is a useful tool to proactively identify gaps or deficiencies. SimLEARN’s Simulation Outreach Network’s (SON) System/Hospital Activation Team is available to assist facilities as they open new clinical spaces or offer new clinical services.

The goal of Systems/Hospital Activations is to identify latent safety hazards using in-situ process-oriented simulation scenarios. The Systems/Hospital Activation Team facilitates simulations prior to opening by observing staff responses to patient flow, workflow, equipment and emergency procedures in order to identify process and system gaps and/or deficiencies. Veteran and staff safety may be compromised by these previously unidentified system or process gaps and deficiencies, otherwise known as latent safety hazards. Once the latent safety hazards are identified, strategies are developed in collaboration with facility staff to mitigate them prior to activation of the patient care area or the implementation of new patient care services.

When a facility desires the SON’s System/Hospital Activations Team’s service the requesting facility sends a formal invitation signed by the facility or VISN director to the team. Through a series of visits and calls the SON team collaborates with the requesting facility to identify potential safety hazards and ideas for simulation scenarios. The SON team then crafts custom scenarios to test the processes and systems of concern. The SON Team returns to the facility in the weeks prior to opening to facilitate scenarios with participants and observers from the service being activated. At the conclusion of each scenario the SON team debriefs the participants and observers to document latent safety hazards and potential mitigation strategies. Finally, the SON team provides a written report to leadership of the findings, the potential risk to patient and staff safety, and mitigation recommendations. Due to COVID restriction some of the team’s process have changed. Virtual technology has been incorporated into the program allowing the team to continue to provide services.

The Systems/Hospital Activation Team has been providing this service to VA facilities since 2012 with the opening of the Southern Nevada Veterans Healthcare System (VHCS). Other hospital activations included the Orlando VHCS, the Southern Louisiana (SLVHCS), and the Eastern Colorado Healthcare System. Based on the positive outcomes at these sites, SimLEARN’s leadership recognized that this valuable service should be offered to all VA facilities opening any new clinical area. 

In December 2019, the Wichita VAMC was preparing to open their new emergency department (ED). The Systems/Hospital Activation Team partnered with ED leadership and staff to identify potential safety hazards and develop simulation scenarios to test their concerns.

Five scenarios were created to test processes and systems such as Veteran check-in, identification and treatment of the Veteran requiring admission, code response, care of the Veteran experiencing suicidal ideation and managing a surge of patients. These scenarios and the debriefings that followed provided an opportunity to explore the groups concerns, identified unanticipated safety hazards, and recommend mitigation strategies. At the completion of the activity, the Systems/Hospital Activation team provided the hospital and ED leadership team a written report of all findings and recommended mitigation strategies. The SON team has also partnered with the West Palm Beach VAMC to help successfully prepare for the opening of their new Domiciliary and the SLVHCS to test processes in preparation for them to begin offering care to Veterans experiencing ST-elevation myocardial infarction in their cardiac catheterization lab.

To request Systems/Hospital Activation support for your facility please email and a member of the SON team will contact you.