July 9, 2024By Erin Carn Bennett

How to Use Healthcare Simulation to Identify Latent Safety Threats

Latent safety threat identification is a critical piece to keep patients safe in a clinical care environment of any description. Healthcare simulation is a highly regarded structure which has the ability to test a clinical environment space and be able to pick up actual or potential latent safety threats to patients. Unintentional harm to patients particularly in the hospital environment is a huge problem across the globe and is increasing as more pressure is placed on healthcare systems alongside global workforce shortages. This article by Erin Carn-Bennett, RN, MSN will discuss how to optimize the use of healthcare simulation to be able to identify latent safety threats in clinical practice.

What is a Latent Safety Threat and Why do They Matter?

Latent safety threats are defined as hazards or conditions that place risk on patient safety but are not obviously apparent without stress being placed on the system. Latent safety threats are errors which can be categorized into types such as: environmental, system based, education, or maintenance. Latent safety threat identification is hugely important as they potentially and often actually contribute to medical errors. Identification of latent safety threats has a significant involvement in patient safety.

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Latent safety threats are important to healthcare simulation for a few reasons. Firstly they are often not obvious to the system user. Secondly, as healthcare simulation staff we are making observations of clinical staff for debrief purposes and have the ability to be able to view latent safety threats more easily. As experts who are able to pick up errors or work-arounds and to be able to enquire in psychologically safe ways to figure out systems based issues, clinical simulation staff are a critical piece to both identification and also solve latent safety threats.

How to Pick up Latent Safety Threats in Healthcare Simulation

Latent safety threats are either staringly obvious to a healthcare simulation faculty member in a clinical simulation scenario or they become evident through the debrief process. Often there may be an indication of some unusual behavior of a clinical simulation participant or an observation of a “work around”. An example of a work around may be use of a bag valve mask to bag a patient from the side of the bed rather than from the head of the bed in an ideal situation. Often events such as this can be attributed to a lack of environmental optimisation for any number of reasons or a lack of education in this skill recently leading to skill decay. However there may be environmental or systems based reasons as well which need identification and exploration.

Examples of latent safety threats that may be noticed by clinical simulation faculty include: inefficiencies in clinical care, near misses or medical errors, knowledge gaps, lack of use of cognitive aids, lack of ergonomic optimisation, product errors, teamwork and communication related issues. First and foremost clinical simulation faculty members should always ask clinical simulation participants in a curious and non judgemental way about what action of interest was observed and what the clinical simulation participants’ perspective on this event was.

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Once identification of the latent safety threat has been made there should be transparency by the clinical simulation faculty about the latent safety threat. Let the clinical simulation participants know that one has been found and that this is a great thing as this can reduce likelihood of harm to patients in the future and this is the intention of healthcare simulation. From here there should also be transparency that this will be reported in a deidentified manner to department leadership so that quality and safety measures can be put in place to resolve the latent safety threat as soon as possible in order to reduce harm to patients.

A clinical simulation team productivity report can be incredibly useful in terms of a metric measurement and also a place to report on latent safety threats identified. A productivity report can be a great way to connect clinical simulation teams to organization leaders and also quality and safety teams. Latent safety threat identification is a great way to demonstrate to funders the value of clinical simulation teams regularly testing clinical environments.

Other ways that latent safety threats can be reported can also include formal course reports that can be sent to department leads after any clinical simulation has occurred. Clinical simulation course reports can follow a template format which may include deidentified participant feedback survey results and information in regards to what education has been provided in the healthcare simulation course. Other points of interest for the report may include: knowledge gaps alongside the identified actual or potential latent safety threats. These reports can also be sent to clinical simulation participants separately as well so that they can see the outcomes from the clinical simulation course in a transparent manner.

Environment Testing Can Pick up Latent Safety Threats with Healthcare Simulation

Environmental testing clinical simulation can be incredibly useful for latent safety threat identification. Environmental testing ideally should be completed in new build or renovated clinical building spaces to try and capture latent safety threats prior to patients being cared for in the new clinical space. Ideally environmental simulation should even be undertaken in cardboard or similar format when plans are drafted by architects in collaboration with clinical simulation to pick up any obvious threats seen by clinical staff as early as possible in the process.

This article has discussed clinical simulation as a useful tool to be able to identify latent safety threats in any clinical environment. Latent safety threat identification can occur in any healthcare simulation based education which is undertaken in a clinical area. Clinical simulation participants should be notified when a latent safety threat has been found in healthcare simulation. An emphasis should be placed on that this is a great occurrence and that this will increase patient safety. Transparency is key and clinical simulation participants should be notified that the event will be reported on in a de identified and no blame way.

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