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.

Identifying and managing latent safety threats though a zone-wide emergency department in-situ multidiscipline simulation program: A quality improvement project

“…Our quality improvement project focused significantly on what Nickson et al (2021) describe as the output stage and our threat mitigation practice practices appeared similar to their described practice of assigning ownership of the identified to the operational decision maker/site leadership, and using focused follow up to ensure resolution. This appeared aligned with the emerging literature (Dadiz et al, 2020;Petrosoniak et al, 2019). Without diligent attention to this phase, we do not feel we would have been able to achieve the lasting change in mitigating threats to patient safety.…”

“…We noted that on 12-month follow-up, 10 threats remained but required ongoing management to alleviate. Previous work identifies that remaining latent safety threats after this time period are not unexpected (Dadiz, et al 2020). However, at two-year follow-up, eight of the remaining 10 threats were mitigated.…”

“…We did not specifically assess interconnection of threats, though we did find that during the threat mitigation process following the simulation, multiple intervention strategies were often required to address a threat such as equipment layout, process change, and staff training (Dadiz et al, 2020). We feel the interconnectedness of common latent safety threats within the ED is an area of interest for future study.…”

Financial and Safety Impact of Simulation-based Clinical Systems Testing on Pediatric Trauma Center Transitions

“…This methodology has yet to gain broad traction in the healthcare arena, as these tools are often deemed too complex, time-consuming, and/or expensive. Various components of simulation have been applied successfully to patient safety, 4 operational readiness, 41 multidisciplinary teamwork, 42 and skills training in critical scenarios such as adult trauma, 43 pediatric emergency departments, 44 and rapid responses. 45 FMEA has been used in the evaluation of radiation and chemotherapy implementation, 10 and communication during transplantation.…”

Staff perceptions and challenges of the single‐family room design—Experience of a greenfield level4 neonatal intensive care unit in the Middle East

“…Surveys suggest that staff perceptions reflected concerns about the early detection of medical crises and adequate patient care in the SFR, suggesting an issue with patient safety in the SFR model 15 . Studies have also alluded to other safety concerns, including communication deficits, missing equipment and supplies, suboptimal staff response times to emergency situations and staffing issues when transitioning from open bays to SFR 16 . Nevertheless, in these studies, the overall benefits outweighed the challenges.…”