Interprofessional In Situ Simulation to Identify Latent Safety Threats for Quality Improvement: A Single-Center Protocol Report

Abstract

In situ simulation has frequently been used to improve team performance and provide an opportunity for the practice of critical skills and identify latent safety threats, which are undetected risks that may lead to adverse outcomes. However, the use of known quality improvement tools to prioritize and mitigate these safety threats is an area requiring further study. Over the course of 9 in situ simulations of a pediatric shock case, postcase debriefs were held to identify latent safety threats in an emergency department and a mixed pediatric and adult inpatient unit. Latent safety threats identified included structure-related threats such as inability to locate critical equipment, knowledge-based threats relating to rapid intravenous fluid administration, and communication-based threats such as lack of role designation. Identification of latent safety threats in the health care environment may assist clinician leaders in mitigating risk of patient harm. The protocol described may be adopted and applied to other critical event simulations, with structured debriefing used as a tool to identify and mitigate threats before they affect the patient.

Keywords: Child; Delivery of health care; Emergency service; Hospital communication; Patient harm; Simulation.

FIGURE 1

Latent safety threats: mixed pediatric/medical-surgical. Those LSTs that occurred only one time are organized into the left column of the chart. The center column includes LSTs that occurred more than one time but less than 3 times during simulations, and those that occurred more than 3 times are in the right column. The y axis was determined by identifying the category of threat and labeling its likelihood of harm to the patient or staff by the quality team through group consensus; the bottom row demonstrates least likelihood of harm whereas the top contains threats with the most likelihood of harm. IO, intraosseous.

FIGURE 2

Latent safety threats: Emergency Department. Those LSTs that occurred only one time are organized into the left column of the chart. The center column includes LSTs that occurred more than one time but less than 3 times during simulations, and those that occurred more than 3 times are in the right column. The y axis was determined by identifying the category of threat and labeling its likelihood of harm to the patient or staff by the quality team through group consensus; the bottom row demonstrates least likelihood of harm whereas the top contains threats with the most likelihood of harm. BP, blood pressure; IO, intraosseous.