Challenges to Implementation of an Incognito Embedded Patient Simulation Program to Improve System-Wide Public Health Threat Preparedness

Abstract

Introduction: Preparing a healthcare system for a special pathogen such as Zika Virus requires that frontline staff be trained to screen, test, educate and counsel at risk patients. The purpose of this manuscript is to describe an innovative intervention that includes an incognito embedded patient simulation and highlight solutions to challenges encountered during implementation. Methods: Incognito embedded patient simulations focusing on Zika preparedness were performed throughout 14 different institutions within one urban healthcare system that provide prenatal care. Challenges to safely and efficiently deploy the program were cataloged. Results Several key challenges were identified: 1) Creation of a patient within electronic health record 2) Ensuring proper patient identification 3) Securing the correct type of patient appointment 4) Patient testing congruent with patient condition 5) Data collection during simulation 6) Maintaining psychological safety before, during, and after a simulated event. Conclusions: This manuscript provides practical solutions to pitfalls encountered while conducting multiple incognito embedded patient simulations to a large, diverse healthcare system.