Resolving latent safety threats identified through in situ simulation: a multicentre mixed-methods study

Area of Science:

• Healthcare safety
• Clinical risk management
• Simulation in medicine

Background:

• In situ simulation effectively identifies latent safety threats in healthcare settings.
• Limited focus exists on the systematic resolution of threats identified through simulation.
• Enhancing clinical safety and system resilience necessitates a structured approach to threat management.

Purpose of the Study:

• To investigate the resolution rates of safety threats identified during in situ simulation courses in Aotearoa New Zealand hospitals.
• To quantify the resolution of these threats and identify factors influencing successful outcomes.
• To explore contextual and experiential factors affecting threat resolution through qualitative methods.

Main Methods:

• Exploratory sequential mixed-methods design across multiple centers.
• Data collection on latent safety threats using a structured reporting tool, with resolution assessed at three months.
• Multilevel regression analysis and qualitative interviews with simulation convenors.

Main Results:

• 278 safety threats identified across 20 courses in 15 hospitals; 28% were resolved.
• Threats related to equipment, environment, and tasks were more resolved than teamwork or organizational issues.
• Smaller hospitals had higher resolution rates; hospital size and threat type significantly predicted resolution.

Conclusions:

• In situ simulation is effective for identifying threats, but resolution remains a challenge.
• Aligning institutional processes with clinician insights is crucial for effective threat mitigation.
• Healthcare systems must actively support threat resolution through clinician empowerment and clear accountability processes.