Identifying Hospital Built Environment Hazards Using HART and FRAM Frameworks: A Clinical Simulation Study

In Situ simulations of work in health settings have been adopted to proactively identify hazards and manage risks related to the built environment (BE). In particular, video-recorded simulations allow repeated reviews and debriefings of scenarios. This study evaluated BE hazards influencing clinical performance and patient outcomes based on video In Situ simulation of emergency scenarios before BE occupation. Four retrospective In Situ simulation and debriefing sessions of two emergency scenarios (ventricular fibrillation and acute myocardial infarction) were conducted with 12 medical and nursing staff participants in a hitherto new resuscitation bay of an Emergency Department (ED) in Australia. Data were analyzed according to the Hazard Assessment Remediation Tool (HART) and Functional Resonance Analysis Method (FRAM) by independent clinical and HFE researchers. Each 10-s video fragment was associated with FRAM functions (i.e., tasks performed), aspects (e.g., input, output, preconditions), agents and variabilities of FRAM outputs to identify latent and active hazards according to the HART categories (i.e., slip/trip/fall/injury risk; impaired access to patient or equipment; obstructed path; poor visibility; and infection risk). HART categories were used to identify BE latent and active hazards, translated into potential and actual variabilities of the FRAM function outputs that arise from the suboptimal BE conditions. FRAM models of each emergency scenario were developed, 45 BE hazards were identified and 18 recommendations to the ED BE were linked to the precondition aspects of FRAM functions as a strategy to mitigate the output variabilities. Our two key contributions were (1) combining FRAM and HART as a methodology; and (2) using clinical simulations to identify BE hazards.