Qualitative analysis of latent safety threats uncovered by in situ simulation-based operations testing before moving into a single-family-room neonatal intensive care unit

Abstract

Objectives: We aimed to identify: (a) latent safety threats (LSTs) in a new neonatal intensive care unit (NICU) through simulation-based pre-occupancy operations testing, and (b) LSTs that remained unresolved 1-year post-occupancy.

Study design: In this qualitative study, 111 healthcare professionals participated in patient care simulations and debriefings in a new NICU. Debriefing transcripts were inductively analyzed to characterize LSTs. Unresolved LSTs were identified 1 year after NICU occupancy.

Results: Thematic saturation was attained after analysis of nine debriefings. Four major themes affecting staff function and patient safety emerged from 305 threats: relay of information, workplace design, patient care processes, and patient family and staff focus. One-year post occupancy, 29 (9%) LSTs remained unresolved.

Conclusion: Team debriefings of simulated patient events uncover LSTs that can largely be resolved before transitioning patient care into a new NICU. Understanding how LSTs interact provides a platform to develop viable strategies to mitigate patient safety risks.

Fig. 1. Latent safety events uncovered from in situ team simulations and debriefings.

Qualitative analysis of team debriefings resulted in 305 latent safety threats that were categorized into different themes and subthemes. Latent safety threats ranged in severity from serious to minor.

Fig. 2. Framework illustrating the relationship between different latent safety threat themes and subthemes.

Qualitative analysis of debriefings led to the development of a conceptual framework that illustrated the relationships between different themes and subthemes of latent safety threats. Relay of information, workplace design, and patient care processes were interconnected. Through greater appreciation of these relationships, institutions may anticipate and mitigate latent safety threats to better support staff function and patient care/safety.