Table 2.

Summary of findings and recommendations

Element/area	Findings	Recommendations	Actioned
Provider/team issues provider Roles and scope of practice Emergency department (ED) Med Surg OB units	• Trauma room/code team formation physicians, respiratory therapist and paramedics in code room, overlapping skill set and roles. • Team composition—addition of health care aid (unregulated) to units lack of understanding of scope (too much to little), partnership with RNs, lack of acute care hospital experience.	• Simulation teamwork training for identifying leader, role clarity, and communication. • Simulation teamwork training/orientation classroom for role clarity and communication.	• First year post-opening focused on team simulations. Elimination of paramedic role • Monthly simulation with IP teams continue in trauma bays • OB Sims monthly nursing
	• No OB on site until September 2014/ ED open January 2013.	• Expand NRP training to ED staff. • Need for precipitous delivery equipment and supplied in ED staff.	• OB orientation day for ED occurred December 2012 • Equipment and supplies arrived prior to opening
Clinical proficiencies Inpatient units ICU code team	• Medications—code team unable to access automatic dispensing cabinets on units. • No crash carts/defibrillators/code team prior to January 2013.	• Orientate nursing staff on role in accessing meds for code team. • Development of airway buckets pre ICU with AED training for staff. • Protocols placed in high acuity areas	• Completed • Airway buckets in effect from 2012 (dismantled with full operation of ICU operational in 2013) • Signage/resources created
Facility issues All units OB	• Code Red/Blue/power outage outside of fire department override during Code Blue; code team over team to use the stairs. • Dedicated OB elevators/OB 7th floor OR on 3rd floor	• Awareness, key to be given to facilities management • ID need to transfer sled to transport OB patients in need of STAT C-section/OR resuscitation • Need for C-section set up on 7th floor	• Key obtained • Site wide fire drills maintained yearly • Transfer sleds obtained • Confidence in elevators/system—not completed
Communication Inpatient units ICU code team Public areas	• Mis-wiring of Code Blue/staff assist buttons • No cell service/outside telephones in hallways for calls on site prior to mid-August 2012	• Immediate follow-up with vendor and facilities management • Staff awareness campaign for accessing hard-wired phones locations	• Wirings fixed and tested prior to opening • New phone lines for main street kiosks
Unintended consequences EMS	• EMS not aware of how to access hospital for pre ED opening	• Tours for all Calgary EMS providers to site	• Completed by October 2012
Emergency department	• Code room setup, pillars hinder access to med cupboards.	• Reconfiguration of carts and trauma room to better serve needs	• Re-configuring and changing of supply carts and resources completed
Adolescent mental health	• Asphyxiation/hanging of mannequin in simulation accomplished in high observation unit	• Management and staff awareness for need to constant observation, patient placement	• Grates fixed by FM and E, staffing and patient assignments changed
Pediatric outpatient clinic	• Pediatric Code Blue lack of pediatric supplies for code blue. No medications available in clinics, lack of specialty knowledge for pediatric crisis	• Identified need to “pack and go” to trauma bay in ED ASAP, meds added to RT outreach bag, stretcher brought to unit for potential transfers	• New pediatric backpack and supplies • Assigned situational role to ICU nurse to recommend when transfer needs to occur