Detecting latent safety threats in an interprofessional training that combines in situ simulation with task training in an emergency department

Abstract

Background: During in situ simulation, interprofessional care teams practice in an area where clinical care occurs. This study aimed to detect latent safety threats (LST) in a training program, which combined in situ simulation scenarios with just-in-time and just-in-place self-directed task training in an emergency department. We hypothesized this simulation-based training in actual care areas allows the detection of at least one LST per simulation scenario. Methods: This prospective observational study (April 2015–March 2016) involved 135 physicians, nurses, and nurse technicians. Training themes selected were arrhythmia, respiratory insufficiency, shock, and cardiopulmonary resuscitation. Simulation weeks occurred every 3 months, with three 10-min scheduled in situ simulation scenarios alternating for each theme daily. The scenarios were followed by co-debriefing by two facilitators (a physician and a nurse). LST were identified by facilitators using a debriefing checklist. Additionally, a room was set up with task-trainers related to each theme. Results: The number participants in scenarios was 114 (84% of the population) and in task-training, 101. The number of scenario cancelations was nine, making the final total number to 49 of 58 proposed. Fifty-six LST were observed, with an average of 1.1 per scenario. LST were divided into four categories: equipment (n = 23, 41.1%), teamwork (n = 12, 21.4%), medication (n = 11, 19.6%), and others (n = 10, 17.9%). There was a higher proportion in equipment-related LST (p < 0.01). Conclusions: The training allowed a high rate of detecting LST regardless of theme. Equipment-related LST were more frequently found.