hallways spanning one quarter of a mile and 36,000 square feet,
double padded surface floors protect feet during walking. Separate
clinical areas like an ICU workroom, a staff lounge, two academic
conference rooms and call rooms allow clinical providers working
facilities to incorporate academic activities and personal wellness
into day-to-day clinical care within the premises of the unit. A
designated staff respite room for non-physician staff with attached
showers allows nurses, respiratory therapists and nursing assistants
to take a break on a busy day.
The move into the newly built unit brought several new
technological features and created the need for new workflows
for daily patient care activities. While the training for new
technology is standard practice for clinical providers, Wake
Forest neuro ICU took innovation to a new level and created a
systemized program to test the new clinical facilities and train
the providers for using the new space. A three-stage simulation
program was designed with multidisciplinary team input. Real
clinical providers participated in these scenarios in their real
clinical roles with high-fidelity simulators or standardized
patients used to create clinical situations.
The first stage was built in a “scavenger hunt” approach to train
providers in “where is what?” for their relevant clinical needs. A
labeled colored map of the unit was created with an “operation
manual” of the new unit and a fully staged patient room with
self-guided tours to familiarize providers with new workflow and
equipment.
The second stage of simulation tested the ergonomics of a
patient room with regard to provider and equipment workflow
in an acute clinical crisis. A high-fidelity simulation was used
to create an acutely deteriorating patient progressing to cardiac
arrest requiring escalating need for equipment like airway, code
and vascular access carts.
The third stage was conducted with several clinical scenarios
in series using actors as standardized patients and high-fidelity
simulation to create a “typical busy in the neuro ICU.” These
scenarios captured major high-risk events like ED to ICU
admission with neurological change during transit, acutely
seizing patient requiring pharmacological management and
patients having an acute ICP crisis with need for airway, external
ventricular drainage and emergent neuroimaging. All healthcare
systems that are integrated into routine clinical care like pager
systems, ASCOMs, medical records; pharmacy dispensing,
environmental services, bed assignment and triage were tested
as a part of this final stage. The “presence and recognition”
of the unit and designated patient space was verified in all
electronic environments. A multidisciplinary team including
clinical providers and representatives of hospital systems like
risk management, triage coordinators, facilities and planning,
information technology, etc. participated as observers.
Each stage of simulation was followed by a debriefing that
allowed an open forum of discussion of observations, concerns
identified and suggestions for improvements by observers as well
as participants. Several safety and workflow issues were identified
and addressed prior to the actual move. This led to a much safer
and efficient move into the new unit.
The new unit recently celebrated its first year anniversary in
February 2016. We continue to build a committed and confident
neuro ICU program with several new additions to our unit
including nurses, neurointenvists and advance practice providers.
Simulation, quality improvement and clinical research are now
closely knit into our academic program. We are proud of how far
we have come. We hope to continue providing excellent clinical
care to our patients in a manner we will like our family members
to be taken care of.
We would love to share more details about our simulation
program or opportunities for employment. Please contact us:
Aarti Sarwal, Medical Director, email: asarwal@wakehealth.edu
Janet Crumpler, Clinical Nursing Manager, email: jcrumple@
wakehealth.edu
Wake Forest Baptist Medical Center is a comprehensive stroke
center with a level 1 trauma center and a growing neurosciences
program that provides all subspecialty support in neurological and
neurosurgical care of patients.
The new neuro ICU was built with several patient- and familycentric
features in spacious private rooms and hallways. Several
enhanced features like booms and ceiling lifts help provide
infrastructure for all nursing and respiratory care. Calm colors and
artwork of natural scenes from around North Carolina create a
nurturing, healing and peaceful environment.
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