Healthcare Design Process

The future is simulated: Simulation-informed design to create a trauma room like no other

By: Andrew Petrosoniak, MD, MSC (MEDED), FRCPC

The care of a trauma patient requires a team of highly specialized clinicians who work together to deliver time-sensitive interventions. This approach has been compared to a Formula 1 pit crew whereby a team descends on the car when it rolls into the pit stop. The team is required to rapidly diagnose and simultaneously repair the car in a matter of seconds. We often imagine that the team must rigorously train to achieve this level of skill but the importance of impeccably designed equipment and space cannot be overstated. The same highly qualified team working in space that’s too small and where equipment can’t be used properly could be disastrous.  Imagine if all members of the team couldn’t fit around the car or if the equipment to remove the tires knocked other team members out of the way? For teams to excel in their function, they need well-designed work environments. In fact, it doesn’t matter how great a team is, if they have to allocate substantial time and effort to overcome design challenges.

Trauma care is no different. High-quality trauma care requires equipment and clinical space that is specifically designed to diagnose and treat the critically injured when seconds matter.

As we look to the future of trauma care, we must seek innovative and radical approaches to meet the needs of the end-users, clinicians and patients alike. We believe simulation-informed clinical design is an essential part of the design process and our recent work proves just how effective it can be.

You can’t design for something you don’t understand

Design must begin with first understanding the end-users: how they work, how they interact, how they move within the space. We began this deep understanding through simulation within the existing trauma bay. We recreated trauma scenarios whereby the entire team responded to and cared for simulated patients. We listened, we watched and we reflected. We learned that the trauma team frequently didn’t have adequate sightlines to the patient’s heart rate and blood pressure monitor. We observed that equipment was scattered around the room resulting in wasted time and effort to deliver life-saving treatment. We established that the trauma team requires at least six feet radius from the patient to move during a resuscitation.

Challenges identified in existing spaces inform the radical design of the future

These findings were provided to the architectural design team and integrated into the plans for the new space. We installed vital sign monitors all around the patient to ensure that it didn’t matter where you stood in the trauma bay, these critical indicators could be seen. We bundled equipment into highly functional modular carts that could be easily moved in and out of the clinical space. Finally, while the original design called for three trauma beds, we established that the space was better suited for two trauma beds with a capacity to scale to three.

We conducted a series of simulations using multiple techniques (tabletop and mock-ups) to validate the new designs.

This allowed us to refine the plans before any construction began. Ultimately, we were more certain that the design would fit and meet our needs. Finally, before a patient ever got treated in the space, we “crash tested” the new space to ensure that everything functioned as intended. We’re fond of saying that no patient should ever be the first to test a new clinical space.

The future of trauma care puts the focus on the patients and those caring for them. When we’re dealing with matters of life and death, we need the clinical environment to work perfectly. Simulation-informed clinical design makes this possible.

Andrew Petrosoniak is an emergency physician, trauma team leader, simulation specialist and principal at Advanced Performance Healthcare Design (APHD). NORR and APHD are collaborating to rethink, recalibrate and reimagine the design process of healthcare facilities and spaces through simulation to inform the final architectural design.