The use of in situ simulation to detect latent safety threats in paediatrics: a cross-sectional survey

Abstract

BackgroundIn situ simulation (ISS) has been reported as an innovative method to identify and mitigate latent safety threats (LSTs) in healthcare. Little is known about the current utilisation of ISS across academic simulation programmes.ObjectiveThis study aims to describe the use of ISS to identify LST across paediatric academic simulation programmes.MethodsA 25-question cross-sectional survey was conducted at two simulation meetings in January 2014 to recruit leaders from paediatric simulation programmes. The total eligible sample was 82 individuals representing 48 distinct academic medical centres. The 25 survey questions were created to describe the constructs of: (1) utilisation of ISS (location, participants, cancellations and coordination) and (2) the outcomes of ISS (detection of and response to safety threats). Descriptive statistics were carried out using SPSS V.21.0 (IBM Corp released 2012).ResultsThe response rate was 68% (56/82), representing 79% (38/48) of the eligible academic medical centres. The majority of respondents (52/56) reported that their programmes utilised ISS. ISS was most commonly conducted in acute care settings. Almost all respondents (48/52) detected an LST during ISS. More than half of the respondents (28/52) utilised a formal reporting process after ISS sessions to feedback the LST to other individuals within their institution. 23% (12/52) of respondents reported the detection of a serious LST in ISS that was not resolved and subsequently led to a safety event during real patient care.ConclusionsThe use of ISS to identify and mitigate LST is common in this cross-sectional survey of paediatric simulation programmes. Diverse processes and organisational structures exist for reporting and mitigating LSTs identified in ISS. A more integrated and systematic approach to ISS and LST could help ensure the mitigation of LSTs before they impact on patients.

In situ simulation in emergency medicine: Moving beyond the simulation lab

“…The enhanced fidelity derived from ‘training where you work’ facilitates LST detection with a resolution that is not possible outside the clinical domain. ISS can be used to identify a broad range of LSTs related to equipment, medication administration and ED‐based processes, followed by direct feedback to providers and administrators with actionable items to effect change in the clinical environment …”

“…A patient's pathway through the ED might involve emergency medical services, nursing and multiple medical and allied health personnel, traversing a large physical space and interacting with a multitude of medical equipment, medication and technology. The opportunity to evaluate a complex system using ISS might provide key information regarding the clinical infrastructure, the potential for error and ‘road test’ solutions …”

Providers' Perceptions of Caring for Pediatric Patients in Community Hospital Emergency Departments: A Mixed‐methods Analysis

“…In‐situ simulations involve the presentation of a patient to an interdisciplinary team of frontline providers in their actual clinical work space using real equipment. These simulations can be used to train providers and teams (especially around low‐frequency, high‐stakes cases) and to probe systems for latent safety threats . Debriefings involve teams self‐reflecting on the simulation experience and provoke participants to express their cognitive and emotional frames .…”

Developing an undergraduate paediatric simulation workshop in a resource constrained setting: A practical ‘how to’ guide

“…This offers the advantage of providing opportunities for a greater degree of realism, familiarisation of available equipment, and discovery of possible latent safety threats within the health-care setting. [13][14][15] However, we ensure that a contingency plan is always in place as such locations may become unavailable at short notice due to clinical demands. Ideally, a separate room for debriefing is also arranged.…”