Development of Rapid Response Capabilities in a Large COVID-19 Alternate Care Site Using Failure Modes and Effect Analysis With In Situ Simulation

Nadav Levy, M.D.; Liana Zucco, M.B.B.S., F.R.C.A.; Richard J. Ehrlichman, M.D., F.A.C.S.; Ronald E. Hirschberg, M.D.; Stacy Hutton Johnson, Ph.D., R.N.; Michael B. Yaffe, M.D., Ph.D.; Col. (ret); Satya Krishna Ramachandran, M.D.; Somnath Bose, M.D.; Akiva Leibowitz, M.D.


Anesthesiology. 2020;133(5):985-996. 

In This Article

Quality Improvement Methods Used to Assess Rapid Response Capabilities

To establish and implement rapid response capabilities within Boston Hope, we applied prospective quality improvement methods such as process mapping, failure modes and effect analysis, and on-site walkthroughs. These methods enable proactive identification of potential hazards and outline opportunities for mitigation efforts. In situ simulation drills were conducted to allow implementation, team training, and further hazard detection. In parallel, the assessment of resource requirements, workflow planning, and distribution of standard operating procedures was undertaken. Through a continuous, rapid-cycling quality improvement process, standard operating procedures were updated and redistributed based on the hazards or gaps in care identified in real-time or through the prospective methods described above. This observational, descriptive study was reviewed by our local Institutional Review Board. Written informed consent was waived (2020P001496).