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First Simulation-Based VA Design Standards Testing Workshop: Emergency Department


Top photo: Resuscitation room constructed from foam display board 18’0”x19’0”; bottom photo: Treatment room constructed from foam display board 13’3”x12’6”. Photos courtsey of LeAnn Schlamb

By: LeAnn Schlamb, MSN, Ed.S, Associate Director for Education Research and Outreach, SimLEARN
Jane Robinson, MSN, RN, CEN, Hospital Activations and Outreach Nurse, SimLEARN
Gary Fischer AIA, Architect, Office of Construction and Facilities Management

Over the last eight years SimLEARN’s System/Hospital Activation collaborated with over 40 separate groups at ten different VA facilities using simulation to identify latent safety threats. Patient care improvement opportunities were discussed with facility staff prior to the opening of their new clinical spaces. We observed that waiting until simulation testing identified these threats and then mitigating them can result in significant cost or delay the opening of these vitally needed services. SimLEARN Outreach Network (SON) System/Hospital Activation team partnered with Office of Facilities Standards Service (FSS), Office of Construction and Facilities Management (CFM) to use Simulation-based Hospital Design Testing (SbHDT) to test designs prior to the start of design and construction.

Emergency Department Design Guides

The “proof-of-concept” to conduct simulation-based testing on VA Design Standards occurred at a testing workshop June 21-24 at SimLEARN’s National Simulation Center, Orlando, FL. The spaces were constructed by SimLEARN staff using foam poster boards to reflect actual square footage. Using information from the design guides, commonly used equipment and supplies were placed in each room to create a realistic environment for the participants.

The goal was to test the safety and functionality of the designs prior to the publication of the of the Design Standards. Identifying these issues before construction begins results in significantly lower design change costs and avoidance of construction related delays.

Details from the SimLEARN System/Hospital Activation/CFM simulations include:

· An interprofessional team of VA emergency department providers, healthcare architects, and simulation experts created a full-scale mock-up of multiple individual treatment areas including representative of equipment and supplies, from the new Emergency Services Design Guide, currently under development.

· Immersive simulation experiences were facilitated to evaluate the safety and functionality of these spaces.

· The team was able to identify positive attributes of the designs to maintain while also identifying potential negative attributes of the designs resulting in adverse impacts to workflow and patient flow, and safety hazards.

· Working together the team was able to mitigate many of the identified challenges and barriers resulting in a more functional and safe design.

· Basic items such as the location of emergency equipment or the orientation of a bed in the room were significantly changed as a result of this activity.

Workshop Outcomes:

· The use of SbHDT will improve the quality and accuracy of VA Design Standards for Space Criteria and Design Guidance. Room sizes and dimensions were established by the Standard Project team. The ED providers and simulation team used common and high-risk clinical scenarios to confirm each rooms ability to accommodate a variety of staff configurates, equipment, and workflows to effectively meet the needs of clinical staff providing care to Veterans. Iterative simulations allowed the teams to evaluate placement of equipment to ensure ultimate functionality. SbHDT allowed the team to validate designs leading to reduce corrective changes during construction and post construction. This process connects the VA Standards development to real-time VA medical center operations, increasing the voice of VA staff in the Standards development process.

Future Plans:

· Continue to fine-tune this work, and the benefits to not only improve VA Standards development but all VA design and construction projects will become more evident.

· The proactive approach will have a direct impact on decisions made during the design phase of clinical spaces and translate into significant cost-savings and/or cost avoidance to VHA, positively influencing the triple aim components of per capita cost, efficient bedside care, and improved Veteran experience of care.

In summary, the results of this workshop are far-reaching. The multidisciplinary collaboration between the three teams will have extensive impact across VA. Space layouts will be standardization across VAs large and small. Significant cost savings will be realized because designs have been validated for function and safety prior to construction. Veterans and staff will be the ultimate beneficiaries of this innovative project.