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Latent Safety Threats and Countermeasures in the Operating Theater: A National In Situ Simulation-Based Observational
Jennifer A Long1, Craig S Webster, Timothy Holliday
1From the Centre for Medical and Health Sciences Education (J.A.L., C.S.W., J.M.W.) and Department of Anaesthesiology (C.S.W., J.T.), School of Medicine, University of Auckland; Department of Anaesthesia (T.H., J.T., J.M.W.), Auckland City Hospital; and Simulation Centre for Patient Safety, Faculty of Medical and Health Sciences (J.T.), University of Auckland, Auckland, New Zealand.
In situ simulation in New Zealand hospitals identified numerous latent safety threats (LSTs) in operating theaters, highlighting the need for collective solutions to improve patient safety. This method effectively pinpoints risks and drives quality improvement initiatives.
Area of Science:
- Healthcare Quality Improvement
- Patient Safety Research
- Surgical Education
Background:
- In situ simulation in clinical settings is crucial for uncovering latent safety threats (LSTs).
- A national simulation program in New Zealand explored LSTs during operating theater training.
- Multidisciplinary teams participated in simulation-based training.
Purpose of the Study:
- To explore latent safety threats identified during in situ multidisciplinary simulation-based training.
- To analyze the types and frequency of LSTs in New Zealand operating theaters.
- To assess the utility of in situ simulation in patient safety improvement.
Main Methods:
- Surgical simulations were conducted in 21 New Zealand hospitals.
- Simulations ranged from 15 to 45 minutes.
- Latent safety threats were recorded using a template and analyzed with the London Protocol's contributory factors framework.
Main Results:
- 77 out of 103 postcourse reports identified LSTs across all London Protocol factors.
- Common LSTs involved staff knowledge/skills, team dynamics, task/technology factors, and work environment.
- Team factors, such as shared mental models, were also noted as protective against adverse events.
Conclusions:
- Latent safety threats are pervasive in surgical departments, with broad relevance across New Zealand and internationally.
- In situ simulation is effective for identifying patient safety threats and initiating improvements.
- The findings support the integration of in situ simulation into the healthcare quality improvement cycle.
