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Identifying latent safety threats through varied modalities: a comparative analysis
Mireille T Gharib1,2,3, Patricia Trbovich2,4, Walter Tavares2,5
1The Department of Emergency Medicine, The Hospital for Sick Children, Department of Paediatrics, Toronto, Ontario, Canada mireille.gharib@sickkids.ca.
BMJ Quality & Safety
|July 23, 2026
Summary
Debriefing identified fewer latent safety threats (LSTs), but a higher proportion were critical compared to video or observation. This highlights the value of different patient safety simulation modalities for uncovering risks.
Area of Science:
- Healthcare safety
- Systems engineering
- Patient simulation
Background:
- Patient safety and systems integration (PSSI) simulations identify latent safety threats (LSTs) using observation, video, and debriefing.
- Understanding the comparative effectiveness of these modalities is crucial for optimizing patient safety.
Purpose of the Study:
- To compare the number, nature, and potential risk of LSTs identified by direct observation, video analysis, and systems-focused debriefing.
Main Methods:
- A prospective observational cohort study involving six unannounced simulations in a pediatric emergency department.
- Latent safety threats (LSTs) were identified by two independent raters, coded using the Systems Engineering Initiative for Patient Safety (SEIPS) framework, and assessed for harm potential using Healthcare Failure Mode and Effect Analysis (HFMEA).
Main Results:
- A total of 2576 LSTs were identified. Video analysis detected the most LSTs (n=1908), followed by observation (n=426) and debriefing (n=242).
- Debriefing yielded the highest proportion of critical LSTs (54.9%), compared to observation (26.3%) and video (23.6%).
- Video analysis was effective for identifying physical workspace and infection control issues, while debriefing highlighted task-specific and communication-related threats.
Conclusions:
- While video analysis detects more LSTs overall, debriefing is more effective at identifying critical threats.
- Different LST detection modalities have unique strengths, informing strategies to mitigate harm and enhance healthcare system resilience.