Simulating a patient's pathway through a new surgical facility: a method to promote hospital safety in resource-poor settings.

Improving hospital safety is challenging in resource-poor countries. Before a new hospital opened in Malawi, we simulated a patient's pathway from admission to discharge, through which we identified associated administrative and clinical activities. Newly recruited hospital personnel enacted the simulation: admission procedures; preoperative clinical assessment; patient preparation for theatre and surgery; safety checks of surgical and anaesthetic equipment; adherence to aseptic technique; postoperative care; and hospital discharge. Hospital personnel were familiar with their clinical and administrative roles. Some essential equipment required repair/recalibration. Additional supplies of oxygen, nitrous oxide and anaesthetic drugs were needed. Policies requiring clarification, forms requiring amendment and general maintenance tasks for completion were identified. The simulation exercise identified areas for safety improvement and thus could be replicated to promote hospital safety elsewhere.