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Process and Quality Improvement

Various simulation methods and levels of fidelity have been used to uncover latent safety threats, enhance leadership and decision planning, and facilitate the prototyping process for introducing new health information technology or biomedical devices into systems of care. Simulation allows individuals to actively test work processes and interventions as solutions are developed and refined to optimize human-system integration.

The CHSPS can apply simulation approaches to enhance quality improvement projects and/or research on multiple levels. Regardless of the type of simulation, evidence based methods for designing scenarios, optimizing debriefing effectiveness, and facilitating quality improvement or systems planning is important to realize the most value from simulation.  CHSPS staff can offer consultation and expertise in the areas of quality improvement and patient safety science, resilience engineering, and human factors and is interested in building collaborations with VCU faculty and other individuals conducting work in quality improvement.

If you are interested in a quality improvement project or are working on developing a quality improvement innovation, health information technology, and biomedical device, contact Cathy Grossman, Medical Director, or Moshe Feldman, Assistant Director for Research and Evaluation.

The Center has developed and implemented specific quality improvement programs in conjunction with medical services in the VCU Medical Center.  These are custom projects but contain common elements in addressing latent failures and resiliency. Each project highlights how simulation was used to identify needs, design interventions, implement rapid QI cycles, and use data to inform effectiveness and design. A resiliency framework is used to complement traditional safety approaches.

Project: Obstetrical Services Failure Mode and Effects Analysis
This is a simulation enhanced FMEA process implemented over fifteen months during L&D renovation at VCU Medical Center.  It involves process mapping of clinical processes, simulations for workflow changes to identify latent failures in proposed work process alterations during a construction project, and testing of processes and rapid cycle process improvement testing in new facilities prior to opening the new unit for patient care.

Project: Surgical Patient Handoffs in the Pediatric ICU
This project was a collaboration between the PICU, CHSPS, School of Medicine, VCU Performance Improvement office, and Office of continuing medical education as part of a grant to develop an interprofessional and integrated CME-Quality Improvement toolbox. Simulation was used at two levels as the PICU team completed their PDSA quality improvement cycle. First, a core simulation scenario was designed around a pediatric surgical transfer case and the team conducted a cognitive walk through simulation to identify information needs and failure modes. Next, a more elaborate mannequin based simulation was conducted to implement and test solutions.

Project: Designing Training and Systems for Biohazard Preparedness
Simulation can provide a useful tool for working with scenarios which are rare, but have exceptionally high consequences for public health such as bio hazard risks associated with a case of Ebola. Simulation offers a tool to better understand critical system and training gaps that might be addressed to improve overall patient safety. The CHSPS works with the health system to identify potential risks, develop a preparedness plan, and deliver simulation based training to address gaps in preparedness and PPE skills.

Project: Gesture Control Interfaces To Support Ebola Response Preparedness
Managing biohazard scenarios such as a patient with Ebola requires specialized  and complex procedures and can prone to errors and potential contamination. Guides, protocols, and other information sources are often difficult to access because of the challenge of maintaining a sterile field preventing an individual from actually touching paper based or electronic interfaces. This project explores the potential of a gesture control device called the LeapMotion to allow individuals to access instructional media, videos, protocols, and other information important for biohazard preparedness. Simulation is used with other usability tools to develop, refine, and evaluate the usability of the device and effectiveness supporting practice of evidence based isolation guidelines and protocols.