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In-situ simulation to ‘road test’ a new paediatric clinical decision unit: mitigating the risk from latent safety threats
  1. Katherine Brooks,
  2. Amutha Anpananthar
  1. Simulation & Essential Clinical Skills Department, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
  1. Correspondence to Dr Amutha Anpananthar, Barts Health NHS Trust, London E11 1NR, UK; amutha.anpananthar{at}

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A new paediatric clinical decision unit (PCDU) has to be opened in our paediatric emergency department (PED) due to increasing pressure in the department and on inpatient beds. Our purpose-built PED is attached to the adult emergency department (ED) and there is one inpatient paediatric ward with 25 beds. The purpose of the PCDU is to improve patient flow in the PED by providing a facility where selected patients could be observed, investigated and treated without needing admission to the busy inpatient ward. Previously this cohort of patients would remain in the ED while awaiting an inpatient bed or investigation results and affect the flow of other patients.

Guidelines were developed for the conditions that could be admitted to the PCDU; initially these were wheeze, febrile illness, head injury without ‘red flag’ symptoms, accidental ingestion of medications and selected other patients awaiting results of investigations which determine whether an inpatient stay is needed. All patients in the PCDU must be investigated, observed and treated within 12 hours  of admission to the unit. The unit had a rota consisting of paediatric and ED teams.

The PCDU was a new concept within our ED, which is part of the complex working system of a busy NHS district general hospital. There is an increasing understanding in the literature that with increasing complexity there is an increasing risk of error. …

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  • Contributors Both authors meet ICMJE criteria for authorship. AA conceived of the idea, organised focus groups and liaised with the Paediatric and Emergency departments. KB and AA jointly designed and ran the simulations and debriefs and coordinated with the medical education department. AA liaised with the emergency department and facilities department to resolve latent safety threats. KB analysed the focus group and simulation data and wrote the manuscript and figure. Both authors edited and approved the final manuscript and figure. Members of the medical education department helped facilitate simulations and members of the Paediatric and Emergency departments voluntarily participated in the focus groups, simulations and debriefs.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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