Simulations help team design most efficient ER

Dr. Gregg DiGiulio examines a mannequin during a simulation to help design the new ER.

A 15-month-old lies in an ER trauma room after being transported by EMS from an adult hospital. Lab results indicate possible kidney failure.

A 6-month-old suffering seizures is being treated in an ER patient room.

A baby has been found not breathing in a bassinette by a babysitter and has been brought to the ER by EMS.

A normal day in Akron Children’s Hospital’s ER?  Not today.

These are 30-minute simulations being played out at the warehouse in Green Township. They’re helping the ER team in its continuing effort to design the most efficient ER, which will be part of the hospital’s new Critical Care Tower.

In previous sessions, the ER team defined equipment needs, room sizes, basic layouts, and the location of support services.

Dr. Mary Patterson is part of the team helping design the new ER and trauma space in the new critical care tower.

This week, ER team members are enacting simulation scenarios created by Dr. Mary Patterson and her staff in the simulation center, to refine the details of the space and determine how it actually works in practice with a patient.

This means fine tuning what’s in the rooms and where everything is placed. Is equipment easily accessed or in the way of staff providing patient care?

ER staff members are assigned roles to play – residents, attending physicians, medical nurses, procedure nurses, recording nurses, respiratory therapists, x-ray techs, anesthesia assistants, observing students, child life specialists, even distraught parents – to evaluate how well the space and equipment work for each member of the team.

The team surrounds the “patients” – mannequins with pulses, eyes that react to light, and breathing and heart sounds – to test the placement and functionality of equipment.

These simulations are videotaped, and with Dr. Patterson leading the debriefing sessions that immediately follow the simulations, team members watch the videos and talk about their own experiences to identify what’s working and what needs to be changed.

As the week progresses and equipment and cart placements are decided, slow-motion simulations will be used to confirm that medications and critical equipment are within the reach of all members of the team, from the tallest to the shortest.  Simulations will also capture patient care at and from ambulance bays.

All of these workshops taking place at the warehouse are part of what’s called a Kaizen, a rapid process improvement event. This will be the last Kaizen meeting for the ER team. Refinements made in this session will be reflected in the completed architectural drawings due by March 8.

Parents, kids create wish list for their ‘dream’ hospital

In a free-wheeling exchange of ideas, the parents who participated in a focus group to help design Akron Children’s Hospital’s new critical care tower clearly love much about the current facility. They hope to see Akron Children’s culture preserved as it grows bigger.

Parents used phrases like, “comfortable,” “bright,” “warm,” “clean” when asked, “What should be the first impression of Akron Children’s?”

Sarah Sanford said she hopes the new hospital tower will remain a place where “everyone you meet with knows your child.”

Megs Pollock and Jackie Smolinski agreed with that sentiment, adding that they didn’t want the new building to be “too sterile,” or to “look like an airport terminal.” In other words, even if it is big, make it feel small.

Parents attending the session included mothers who had newborns in Akron Children’s NICU as well as those who come to the hospital often with children who have complex healthcare needs.

While the parents talked about what they wanted in the new building, a group of kids were in a nearby room drawing pictures of their “dream” hospital and sharing their own opinions.

While Michelle Ott talked about the importance of having automatic, wheelchair-accessible doors that her daughters could open themselves, 13-year-old Jenna Ott drew a picture of a hospital room with a canopy bed, a “gummy bear” bean bag chair, and lots of pink and purple.

Jenna’s design was conservative compared to other kids who envisioned robots, roller coasters, an ice rink and a beach incorporated into the new hospital.

“I love that kids were invited to this event and that they have a say,” said Michelle.

Jenna has had 20 surgeries so far in her young life and older sister, Alix, who also attended, has undergone more than 50 surgeries. The Ott girls were excited to think that they may actually see some of their ideas in place when the hospital tower opens in 2015.

The parents were also asked what they appreciated about the existing facilities, what they would like to change, and the best way to create a healing environment.

Parents associated healing with kind-hearted, friendly people, serene colors, natural light, music and water.

MaryBeth Fry said NICU moms would get hope from seeing pictures of preemies juxtaposed with pictures of the same children doing well in middle school, high school or college.

Even if the NICU gets bigger – with individual rooms – Fry and the other moms want the new space to balance their need for privacy while giving them the opportunity to meet, develop a support group and maybe even become lifelong friends.

“Research shows that when you reduce stress for parents, you reduce stress for the child,” HKS architect, Rachel Saucier, told the group.

‘Saving lives’ in a mock trauma room

It’s 3 a.m. in the ER when the call comes in. There’s been a car accident. A 16-year-old boy – unrestrained and the driver – is being life-flighted. He is in respiratory distress and has head injuries.

His 10-year-old brother and front-seat passenger is coming by ambulance. His injuries, neck pain and an obvious deformity to the lower body, appear less serious.

The team – a doctor, nurses, a surgical resident, transport team members, staff from lab and radiology, and others – gather in a trauma room. But this trauma room is different. Its walls are made of Falconboard® (heavy duty cardboard) and it’s actually in a 90,000 square foot warehouse where stacks of new automobile tires seem more “in place” than a pediatric medical team.

The mock drill is part of the innovative process Akron Children’s Hospital is using to design its new medical tower, which will include a new emergency department, neonatal intensive care unit, outpatient surgery center and expanded clinical areas.

Leading the mock trauma drill is Laura Pollauf, MD, director of Emergency Services for Akron Children’s Hospital.

“Our goal with this scenario is to really test the size of this room,” said Dr. Pollauf, through a megaphone with the team assembled around her. “When we have a trauma like this, we can have up to 16 people in the room, including the doctor, three nurses, a trauma surgeon, a lab tech, a fellow, child life, a social worker, and the parents.”

During the scenario, the participants pay attention to details. Is the hallway wide enough for a stretcher? Is life-saving equipment in quick reach? Where will the mother enter and how will she be escorted to meet her sons? If the mother is being registered near her children, will this create a bottleneck in the hall?

Jackie Smolinski, a mother of three, including a son with special needs who is well known in Akron Children’s ED, raises the concern that the 10-year-old boy may be traumatized by seeing his older brother undergoing life-saving measures. But Dr. Pollauf suggests that a pull-back curtain could help with that while still allowing the mother to be with both her sons.

Smolinski and five other mothers who serve on the ER design team have also raised issues such as the need for more restrooms in the ER and a larger waiting room, giving Security a stronger presence, and improving overall flow and wait times.

After an informal discussion about the trauma scenario, team members emerge from their cardboard maze ED and return to tables in another location of the warehouse. They will discuss what they liked and didn’t like in the scenario with architects, engineers and construction team.

The goal is to get the design perfect. So when Akron Children’s new emergency department opens in 2015, it will be more than ready to care for two brothers hurt in a 3 a.m. car accident and all other patients who enter its doors round the clock.

Learn more about Akron Children’s building expansion project, called “Building on the Promise.”

Integrated Lean Project Delivery flips the design process

For the past few months, hospital leaders, patient families, doctors, nurses and clinical staff have been meeting regularly with architects, builders and Akron Children’s Lean Six Sigma process improvement team to plan the new patient tower, which is part of a $200 million expansion.

The process, known as Integrated Lean Project Delivery, is expected to:

  • improve productivity
  • eliminate waste
  • enhance the overall patient experience

It’s expected to reduce costly change orders in the construction phase and the project’s overall cost.

“We plan to build flexibility into our design so that we can be prepared for the changing health care environment,” said Grace Wakulchik, chief operating officer. “For example, we are designing our new neonatal intensive care units so they can become pediatric intensive care units or even general patient rooms if our patient volumes and patterns change.”

Akron Children’s Chief Operating Officer Grace Wakulchik

Department teams, in conjunction with the architects, are using small scale models, including paper dolls, to design their floors. Blueprints will be tested in full-scale mock-ups constructed in a local warehouse.

This will allow doctors, nurses and patients to walk down hallways, enter exam rooms and reach for supplies – catching potential problems – well before the real construction begins.

Construction will begin in the spring of 2013 and will be competed in 2015.

The companies assisting Akron Children’s with project management include: