‘We were looking for failures.’ Inside a new GTA hospital’s dress rehearsals as it prepares for ... anything

Thestar.com
Nov. 30
Megan Ogilvie

At first glance, nothing seems out of the ordinary in this busy corner of a hospital emergency department.

A patient lies on a stretcher, eyes closed, a monitor tracking vital signs. Two nurses work nearby, one typing at a computer, the other listening with a stethoscope to the patient’s chest. A physician steps into the room with a smile and assurances he can help.

But then there is a prolonged pause, some nervous laughs and the action stops. Several people clustered in the hallway check clipboards before explaining the next steps in the detailed sequence. Seconds later, the nurses and physician are again bustling at the patient’s bedside.

Staff here at the Cortellucci Vaughan Hospital are 20 minutes in to a two-and-a-half-hour mock scenario to test medical protocols and procedures ahead of the hospital opening its doors to patients in early 2021.

Construction on the long-awaited hospital, located near Canada’s Wonderland and a part of Mackenzie Health, was completed at the end of August.

Now, as the 11-storey building gets its final touches, staff are trying out patient monitoring devices, practising workflows, logging in to new computers and running through all the many “what-ifs” to ensure they can safely deliver care in the new building.

“We’ll be doing many dress rehearsals, right up until we open, making sure that every single piece of equipment, every single piece of technology and all of our staff are ready to go,” said Mary-Agnes Wilson, Mackenzie Health’s executive vice-president, chief operating officer and chief nursing executive.

“We are testing and testing, and training and training until we get it all right.”

This mock scenario -- one of four that took place during a week in mid-November -- starts in the ambulance bay of the Vaughan hospital’s Magna Emergency department.

It follows a patient, an 84-year-old male named Henry, who has fallen at his long-term-care home and comes to hospital in an ambulance with a suspected hip fracture. He has dementia and staff at his long-term-care home, which has an outbreak of COVID-19, say he has symptoms of the virus, which triggers infection prevention protocols that must be followed at each point of his hospital stay.

The 76-step scenario tracks the patient from his private room in the emergency department to medical imaging for a hip X-ray to an operating suite for surgery to the critical care unit, where he will recover in a negative-pressure isolation room to complete his hospital stay.

While some of the steps are done in fast-forward -- the surgical procedure itself and the mock intubation after the patient’s vital signs become unstable on the operating table, for example, are completed in seconds -- others are followed in precise detail. Transport staff follow an exact route between departments; nurses communicate and issue orders using the electronic medical record; bar-coded samples are whisked from the emergency department to the hospital laboratory via a pneumatic tube.

“We were working with as much equipment and technology as is operational at this point in time to get the look and feel of being in the hospital,” said Wilson, adding this surgical scenario was proposed months ago because accepting a patient from another facility into the emergency department is a common occurrence at Mackenzie Richmond Hill Hospital.

The same week, staff worked through three other mock scenarios: one involving a patient referral from a family physician, one that tracked a patient in a mental health crisis, and one that cared for a pregnant woman whose unborn twins were in distress.

In each case, more than two dozen staff, primarily from the hospital’s quality and patient safety department, observed the hours-long scenarios, and a videographer recorded the simulations, which were viewed and evaluated during a series of debriefing sessions.

Melissa Rowe, a registered nurse and Mackenzie Health’s project lead for operational readiness, said the four simulations incorporated as many different hospital programs and workflows as possible, as well as several worst-case scenarios, including a medical emergency code blue.

And while her team wanted the scenarios to generally go well after months of preparations, Rowe said it was even more important to find ways to improve hospital care, from the placement of hand sanitizer in the emergency department to improving the workflow in the operating suite.

“We were looking for failures, and when we found them, we celebrated them,” she said. “Because finding failures now, months before we open, means we have the opportunity to rectify them, to make it better, before we begin to train our front-line staff.”

Physicians, nurses, transport staff and others from the Richmond Hill hospital participated in the mock scenarios, primarily as themselves, while the roles of patients were taken up by hospital volunteers. To preserve personal protective equipment, participants used surgical masks and gloves rather than the N95 masks and sterile PPE that would be protocol for a patient with suspected COVID-19.

Retired nurse Kim Dooner, who played the part of 84-year-old Henry, said she jumped at the chance to help her former colleagues get the new hospital ready for patients. It also gave her a first peek inside the building.

“The technology is unbelievable,” she said, while lying on a stretcher in a critical care room and gesturing at the computers, tablets and smartphones being used for her care. “There would definitely be a learning curve for someone like me.”

Mackenzie Health is recruiting 1,500 staff and training more than 3,000 ahead of opening the new Vaughan hospital.

While the pandemic has put additional pressures on its hiring strategy, with health-care workers in high demand, Wilson said the two-year recruitment plan has included offering internal training to staff for hard-to-recruit positions, such as critical care nurses.

“We are in the same boat as other hospitals in trying to recruit and maintain staff in the pandemic,” Wilson said. “We’re providing support for long-term-care homes. We’re staffing (COVID-19) assessment centres. We’re moving staff into a lot of different spaces. Staffing is something that we’re watching very carefully.”

Just about everything inside the Vaughan building, from the hand sanitizer stations to in-patient beds, will be aided or controlled by a computer. And all of it must go through a trial-run before the “smart hospital” sees its first real patient, said Rowe.

“We’ve done a thorough test of our nurse call system; it’s the life-saving system within the building,” she said, noting teams have tried out and double-checked each of the hundreds of red nurse call buttons and pull cords in the hospital.

“We’ve tested our pneumatic tube system over and over because it will deliver all the patient specimens to the lab and bring blood products to patient care units. We’ve run different scenarios through our PA system, including code blue announcements, to ensure they can be heard in every room, every unit.

“We know we are going to find problems, but then we have an opportunity to fix them before we actually have patients in the building.”