[audio:http://www.wdde.org/wp-content/uploads/2014/10/Green-10172014-2-AIDupontMove.mp3|titles= Delaware Public Media's Tom Byrne and contributor Eileen Dallabrida discuss A.I duPont Hospital's move into new expansion.]
It’s 8:15 a.m. at the new Pediatric Intensive Care Unit (PICU) at Alfred I. duPont Hospital for Children when a 6-year-old boy with a head injury is rushed to the unit from the emergency room.
Nurses are having a problem installing an extender they need for a drip line. They also aren’t certain where to find the intubation cart that contains the equipment needed to place a flexible tube in the boy’s trachea to help him breathe—or even how to get to the storage unit.
Through lots of trial and error and abundant teamwork, nurses get the drip installed. The cart is retrieved and wheeled into the room. Nurses also reposition the patient’s bed, placing it on the diagonal to ensure easier access for his caregivers.
The scenario sounds like chaos. But it’s actually a simulation, a high-tech dry run of sorts that gives the staff an opportunity to practice on medical manikins before they begin caring for real-life patients.
“It’s like a puzzle,” says Heather Sobolewski, a registered nurse and simulation education specialist. “What is the best way to set this up?”
Nemours/AI Hospital runs "Day in the Life" scenarios to prepare for moving patients to their new addition.
Nemours/AI Hospital runs "Day in the Life" scenarios to prepare for moving patients to their new addition.
[flashvideo file=http://www.wdde.org/wp-content/uploads/2014/10/ai-picu-move.flv image="none"/]
The idea is to practice various scenarios so the staff is prepared when they occur in real life. It’s a strategy that originated in flight training in which pilots learn to cope with simulated disasters to prepare them for a real-life emergency.
“You can’t practice landing a plane on the Hudson,” says Maria Carmen Diaz, M.D., a pediatric emergency specialist and director of simulation at Nemours Institute for Clinical Excellence (NICE). “Our goal is to test the space and stress the system and identify safety issues,”
The doctors, nurses and respiratory therapists are practicing on high-fidelity manikins that can be programmed to duplicate a variety of scenarios.
“We can make them turn blue, we can change their size, we can make their tongues swell up,” Diaz says.
The new PICU is part of an ambitious $275-million expansion at A.I./Nemours that also includes 144 single-patient rooms that can accommodate both kids and their families, a state-of-the-art emergency department and a rooftop helicopter pad. A five-story atrium incorporates a healing garden and interactive Discovery Zone for kids and their parents.
Dr. Glenn R. Stryjewski, the PICU’s medical director, says private rooms outfitted with baths and seating areas are a vast improvement over the old design, in which only three of 22 patient rooms were equipped with bathrooms. That meant the families of kids in the other rooms shared a hall bath.
“For a family with a critically ill child, having space and the comfort to stay with their child is extremely important,” he says.
In addition to attracting patients, Stryjewski believes the state-of-the art facility will give Nemours a big boost in recruiting the best and brightest talent.
“This will help to attract high-quality personnel to our area, away from Philadelphia, D.C. and New York,” he says.
The PICU serves the sickest patients in the hospital, including kids who are recovering from major surgeries, trauma, infectious diseases and cancer. That’s 1,400 patients a year, with an average length-of-stay of seven days. One child has been hospitalized in the current unit for 16 months.
In the new PICU, there will be 24 units, including specialized rooms for infectious illnesses that are outfitted with sterile anterooms.
Each room is equipped with a pair of mobile high-tech booms that will accommodate pumps, gasses and other mechanisms, replacing the old system of plugging machines into electrical outlets located on the wall behind the bed.
It’s a radical shift in routine for the staff, who are trying out various configurations for the booms to accommodate different scenarios.
Dr. Marisa Meyer, a critical care intensivist, practices placing a central line, a catheter inserted in a vein to deliver fluids and medicines. But when she positions the booms, she is unable to see the ultrasound image she needs to perform the task.
“The screen is a little far,” she says.
Diaz suggests repositioning the bed.
“You have the fabulous opportunity with the booms to make the room any way you want,” she says.
Moving the bed to the center of the room enhances flow. But Meyer is concerned that the door to the bathroom will get in the way. She also wants to ensure there is enough space for parents to be present for the procedure.
“Where will we put the parents?” she asks.
Moving a cart into a niche large enough to hold a wheelchair would help free floor space. But the cart is too large to fit.
After shifting through several scenarios, the team comes up a configuration that makes everyone comfortable. The bed is placed on an angle and the boom that accommodates various gasses is placed behind the head of the bed.
“This is an added layer of complexity,” Meyer says.
Throughout the morning, various teams train. Their challenges include a code blue, a child with a head injury whose vital signs are plummeting—and then another code blue is sounded down the hall.
“You have to decide how to best use your resources,” Diaz says. “Who takes care of which patient?”
In addition to high-tech simulations, NICE trains the front-line staff using actors who replicate problematic scenarios.
“What do you do if the parents are arguing?” Diaz asks. “What do you do when the family is upset?”
The big move the staff is practicing for was pushed back from mid-October to Nov. 1 and 2. Ventilators, syringe pumps, medicine pumps and beds will be installed from the old unit. Everything else is new, down to the office chairs at the nurses’ station.
The most important and intense part of the move is transporting very ill patients. Stryjewski says there will be a one-to-one ratio of nurses to patients, in addition to a beefed-up staff of doctors and respiratory therapists.
Because there can be a slight delay in receiving text messages, the staff communicates via walkie-talkies that look like smartphones.
Despite meticulous planning, there’s a potential wildcard on moving day. For example, the PICU population averages 16 patients. But if there’s an especially virulent bug or a large accident, the ranks could swell to 22 patients.
“The move day offers exceptional challenges, especially if we have a high population, some of whom have to be hooked up to a ventilator or other equipment,” Stryjewski. “The idea is to get the sickest patients settled first.”