166 - Integrating Patient Safety and Simulation: Improving Pediatric Stroke Care with In-Situ Simulation and Healthcare Failure Mode and Effects Analysis (HFMEA)

Publication Number: 4163.166

Marissa G.. Perry, MaineHealth, Portland, ME, United States; Madison Doane, Maine Health Barbara Bush Children’s Hospital, Portland, ME, United States; Jamie Fey, Tufts University School of Medicine, Portland, ME, United States; Leah Mallory, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, United States; Alexa Craig, Tufts University School of Medicine, Scarborough, ME, United States; Jillian Gregory, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, United States

Background: Pediatric stroke is associated with high morbidity and mortality, ranking among the top 10 causes of death for children. If acute ischemic stroke is quickly identified, certain patients can receive thrombolysis or mechanical thrombectomy, improving outcomes. Best practice suggests treatment within 2 hours of presentation. The MaineHealth Barbara Bush Children's Hospital is a tertiary care center in Maine, providing comprehensive pediatric care, including stroke management.

Objective: Apparent Cause Analysis (ACA) and focus group feedback revealed delays in imaging and treatment in pediatric stroke care. A Fishbone Analysis and Impact/Effort Matrix identified improvement opportunities. To improve urgent management, a new pediatric stroke pathway and team were created. Given the high-acuity, low-frequency nature of pediatric stroke, in-situ simulation and HFMEA were used to test the new pathway and identify, prioritize, and mitigate latent safety threats (LSTs). This approach ensures patient safety while planning proactively.

Design/Methods: This project was deemed non-human subjects research by the MaineHealth IRB. Educational sessions introducing the new pediatric stroke pathway were held in Jan-Feb 2025. In Mar 2025, an interprofessional team conducted an in-situ simulation, aimed to test stroke recognition, pathway activation, and team response. Thirteen clinicians from six professions participated. A structured debriefing followed immediately to identify LSTs. An HFMEA rubric was used to categorize the LSTs and assign a hazard score, based on its probability and severity.

Results: During the in-situ simulation, the team identified the stroke-like symptoms, activated the new code (4 min.), ordered imaging (10 min.), and initiated transport (12 min.). Six LSTs were identified, three rated critical (hazard score ≥ 8) (Fig. 1).

Conclusion(s): HFMEA with in-situ simulation and structured debriefing proactively tested the new pediatric stroke pathway and analyzed LSTs. This approach enabled pathway practice while identifying vulnerabilities and evaluating interventions. More patient encounters are needed to determine statistical improvement and sustainability. Studies in adult populations show that training and process optimization can reduce time to treatment, improving outcomes. Reduced delays in recognition, code activation, and coordination are expected to shorten time to imaging and treatment.

Fig. 1. LSTs with hazard scores and mitigation plans