Workflow simulations can be used as way of understanding how systems will be fit into workflow and specific physical work environments, according to a narrated electronic poster presentation at the 2009 Healthcare Information and Management Systems Society (HIMSS) conference this month in Chicago.

Kay Lytle, MSN, director of nursing informatics with Duke Health Technology Solutions at Duke University Health System in Durham, N.C., discussed strategies for using workflow simulation to evaluate technologies as a component of a selection process.

“The benefits of using simulation are to identify the impact of technology on workflow; examine possible negative consequences; develop potential workarounds and assess physical environment limitations,” she wrote.

When designing a workflow simulation, it is important to consider the team needs on the basis of the system under consideration, Lytle counseled. This entails identifying who will be users of the system such as nurses, pharmacists, physicians, technologists, or other healthcare professionals.

“A key group will need to develop the clinical, business or normal practice scenarios,” she wrote. “Consideration should be given to ‘corner cases,’ such as isolation patients, for equipment selection. Identify what is important for evaluation in each individual technology selection process such as spacing, identification of possible workflow workarounds or identification of additional corner cases.”

Consideration must be given to what can realistically be simulated, Lytle noted. Space to conduct a simulation must be identified and, if at all possible, a realistic patient care area should be utilized.

The next step is for the group to script what will be explained to the participants and what will be mimicked by defining the steps and process for conducting the simulation scenarios.

“Scripting can be used to create a more repeatable process that allows for greater participation over a period of time,” she observed.

Tools should be used to solicit feedback during each phase or scenario of the simulation and the overall preferred selection. These tools can also provide both quantitative and qualitative data that can assist in making the system or technology selection.

Lytle used the technique to conduct a medication redesign at her facility.

“The project was undertaken to select a medication distribution method such as automated dispensing cabinets, centralized medication carts and medications at the bedside,” she wrote. “Additionally, the project reviewed the interaction the nurses would have with the new electronic medication administration record and bar coding; including the specific computer device options such as computers at the bedside, mobile cart-based workstations, and handheld devices.”

The team created a simulation that entailed three nurses running through each medication administration scenario with each of the input device options. The participants were debriefed to provide feedback on their preferred method, safety and other concerns.

Observers noted how effective each administration process was as well as if anything in the space interrupted the administration workflow. They also documented work arounds implemented by the nurses and any changes to patient interactions. In addition, they shared any safety concerns that arose during the simulations.

By conducting the simulation in different clinical areas and with different nurses, the team was able to determine that unit type (such as ICU, adult patient, pediatric patient, and intermediate care areas) had varied medication administration preferences as well as input device requirements.

The challenges to implementing a workflow simulation are that it is time consuming, requires extensive prep work and that only limited staff can participate in the scenarios at one time. However, by using an actual patient care area and engaging a variety of support resources a workflow simulation can be a valuable product selection tool, Lytle noted.