Introduction:

University Hospitals Dorset (UHD) relocated maternity services into a newly constructed building. Transformational simulation is an effective method for identifying safety threats and driving healthcare improvements [1]. Research is limited on transformative simulation for maternity relocations. This project aimed to use simulation to identify latent safety threats in a new maternity unit and explore the impact on staff.

Methods:

Prior to opening, twenty mandatory in situ Multidisciplinary Team (MDT) simulation days were delivered for 682 staff due to work in the new maternity unit. Simulations were co-produced and co-facilitated by simulation, maternity, obstetrics, anaesthetics, transfusion, theatres and porters. Participants received a day’s training, split into three groups of 10–15 people incorporating orientation and rotation through three simulations - Sepsis, Major Obstetric Haemorrhage and Eclampsia – running simultaneously. Simulations required transfers, with locations varied to identify safety risks throughout maternity. MDT debriefs identified safety threats, which were recorded on a risk log and escalated to senior management. Mixed-method data was collected via participant questionnaires after each day to assess impact on staff.

Results:

Main safety threats:

• Increased time for blood collection, due to increased distance from transfusion.

• Removal of dedicated maternity porter.

• Staff not trained in blood collection.

• Unfamiliarity with department name and location during emergency phone calls.

• Lack of adequate signage.

• Staff injured during pool evacuations due to new shaped birthing pool.

Improvements:

• Increased O-negative blood supply in Maternity emergency fridge.

• Automatic printing of blood collection slips to transfusion.

• Allocation of general porter for urgent blood collection.

• Staff blood collection training.

• Location prompt cards adjacent to phones.

• Improved flag style wayfinding signage.

• Suspension of new birthing pools until alternative evacuation equipment tested.

Impact on staff: Most participants reported increased confidence; 25% reported no change, and 7% reported a decline.

92% felt positive their contributions were valued.

Discussion:

This project identified latent safety threats within a new maternity unit using in situ simulation, leading to real-time improvements. While the overall impact on staff was positive, the decrease in confidence for some - likely due to the identification of safety threats without immediate solutions - suggests the need for further research on managing staff confidence whilst identifying safety threats. Feedback highlighted the value staff placed on orientation simulations, expressing a desire for further sessions. Key lessons for future transformative simulation include the importance of sufficient equipment in proposed locations, formal safety escalation processes and timely feedback to participants.

Ethics Statement:

As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable

References

1. Furthmiller A, Sahay R, Zhang B, Dewan M, Zackoff M. Impact of a relocation to a new critical care building on pediatric safety events. J Hosp Med. 2024;19(7):589–595. doi: 10.1002/jhm.13324.

Acknowledgements/Funding Declaration:

Thank you to Andrew Lawrence, Thomas Randall-Turner, Sam Pask, Lucy Hyde, Julie Flint, Jane Morley-Smith, Kerry Horley, Emma Barton, Fay Tomlinson, Samantha Boullin, Vikki Chandler, Clare Thompson, Bernadette Gowland and all who helped facilitate.