O16 PSSST!: Using a patient-specific simulated systems test (PSSST) to review system performance and latent safety risks when assessing and planning an individual patient-specific pathway, improving patient and hospital outcomes

Abstract

Introduction Simulated system tests can be used to address system errors, improve system performance, patient safety and quality of healthcare1,2. The University Hospitals Bristol and Weston Simulation Services (UHBW SS) adapted this simulation model to review the potential system performance of an individual patient pathway to improve patient outcome. Background Patient X is a 2-year old female with complex medical background, tracheostomy and posterior fossa pilocytic astrocytoma requiring 6-week radiotherapy course under general anaesthetic. The primary complicating factor for the patient and radiotherapy journey was brainstem dysfunction resulting in frequent breath holding spells, respiratory arrest and subsequent hypoxic cardiac arrest. Due to the high-risk nature of the patient, UHBW SS paediatric team designed and delivered a patient-specific simulated systems test (PSSST) simulating patient X’s intended radiotherapy pathway to identify and address latent safety threats. Methods We designed and delivered the PSSST using a basic, low-fidelity ‘walk-through’ simulation model, simulating each step of patient X’s radiotherapy journey. Staff involved in the patient’s care and radiotherapy treatment were present, including anaesthetic, general paediatric, HDU and nursing teams, paediatric critical care outreach, radiotherapy and hospital porters. We did not run simulated acute emergencies, instead adapted the use of reflective pauses, addressing anticipated complications at each stage of the journey. Issues identified were further discussed in a modified debrief following the simulation and action plans formulated. Members of the MDT were allocated tasks, with clear instructions and dates of when they were to be completed by prior to the radiotherapy course commencing. Examples of issues identified: Emergency equipment and staff required for transfer Need for personal protective equipment (PPE) in light of COVID–19 pandemic Environment familiarity for the patient to reduce risk of breath holding spells secondary to agitation/anxiety Results The PSSST of patient X’s radiotherapy pathway identified clinical and ethical implications on both the patient and wider hospital triggering further senior discussions prior to proceeding with her treatment. Latent safety threats were identified and addressed in a timely manner. As a result of this PSSST, patient X underwent an uneventful radiotherapy course without complication or adverse impact on the wider hospital. Discussion This exercise has identified how basic, low-fidelity simulated MDT system tests can be adapted to review system performance of an individual patient-specific pathway, improving patient and hospital outcomes. We aim to expand the use of PSSST for assessing and planning individual patient pathways in the future at BRHC. References Vincent C, Moorthy K, Sarker SK, et al. Systems approaches to surgical quality and safety: from concept to measurement. Annals of Surgery2004;239:475e82. Aggarwal R, Mytton OT, Derbrew M, et al. Training and simulation for patient safety. Quality and Safety in Health Care 2010;19(Suppl 2):i34-i43.