In the post-anesthesia care unit on the second floor, for example, a team of nurses, physicians, laboratory personnel, imaging staff, patient experience representatives, lift specialists, respiratory therapists and patient access staff cared for an unstable patient. When the nurse called for a lift team, the first issue of the morning was identified. The wheels of the lift device were too wide to get through the patient room door.
The “patient,” an elderly woman well prepared for her acting debut, began shivering. Together, the care team followed the detailed steps of the scenario, traveling en masse to a nearby warming drawer for a blanket and to the Omni cell, an automated medication dispensing cabinet, to retrieve a needed medication. When the nurse identified that the patient was bleeding, an order was placed for blood. Unable to control the bleed, the nurse paged the attending physician. As the patient’s condition worsened, she called a code. Throughout the scenario, the staff paused to review each step and make small adjustments to their workflows.
“We test every step,” said Ann Cullen, MS, RN, clinical transition director for critical ambulatory care. “Anytime you move staff into a new space, they have to get familiar with the new footprint.”
Downstairs, a team in the emergency department readied themselves for an incoming trauma victim. A 60-year-old woman with a blunt force injury from a high-speed collision was arriving by ambulance in five minutes. Treatment Bay Three was packed with trauma attending physicians, residents, nurses and observers. The team ran through their roles, identified the locations of the nearest supply cabinets, crash carts, medication Omni cells and defibrillators, and practiced operating the new overhead boom light.
As the patient moaned in pain, the team called for a portable X-ray. When the patient was transported to the CT room, the entire entourage followed the gurney, cramming themselves into the imaging area, and then over to the elevator bays as the patient was sent to surgery. The location of supplies, crash carts and defibrillators was heavily discussed, and finding the fastest path of travel from the emergency department and CT rooms to the operating rooms above was identified as an outstanding issue.
Fictitious patients lend a real-life quality to the role-playing, Wilmot said. “When you have a patient you’re caring for, people are used to moving a certain way to get what they need. They have muscle memory,” she said. “Dress rehearsals let teams change their muscle memory from the existing hospital to the new hopsital and adapt to their new environment.”
Future training milestones
With just two full days of cross-functional team dress rehearsals, every patient care team and department has been in the new hospital multiple times, conducting department-specific training in their new space.
Further fine-tuning will take place this month when the Office of Emergency Management will hold a three-hour, hospital-wide mass casualty exercise. Later that same day, a facilities team will be on-site, testing all of the building’s systems — badge readers, nurse call buttons, elevator entrapments, overhead paging, pneumatic tubes. Further resolution of issues identified during dress rehearsals will be ongoing, with some teams running mini-simulations to work out final changes. An operations command center will be set up in the new hospital and will run through a final mock drill to prepare for final occupancy approval.
“We know how to do the clinical work,” said Alison Kerr, vice president of operations at Stanford Health Care. “But in the new space, with new equipment, new technology, new workflows and different disciplines working together, we have to practice so we get that operational discipline down with a high degree of reliability. We don’t ever want to get anything wrong.”
Photos by Thru Luke's Lens
First published on Stanford Medicine News Center by GRACE HAMMERSTROM.