Trauma Resuscitation Using in situ Simulation Team Training (TRUST) study : latent safety threat evaluation using framework analysis and video review

© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ..

INTRODUCTION: Trauma resuscitation is a complex and time-sensitive endeavour with significant risk for error. These errors can manifest from sequential system, team and knowledge-based failures, defined as latent safety threats (LSTs). In situ simulation (ISS) provides a novel prospective approach to recreate clinical situations that may manifest LSTs. Using ISS coupled with a human factors-based video review and modified framework analysis, we sought to identify and quantify LSTs within trauma resuscitation scenarios.

METHODS: At a level 1 trauma centre, we video recorded 12 monthly unannounced ISS to prospectively identify trauma-related LSTs. The on-call multidisciplinary trauma team participated in the study. Using a modified framework analysis, human factors experts transcribed and coded the videos. We identified LST events, categorised them into themes and subthemes and used a hazard matrix to prioritise subthemes requiring intervention.

RESULTS: We identified 843 LST events during 12 simulations, categorised into seven themes and 38 subthemes, of which 23 are considered critical. The seven themes relate to physical workspace, mental model formation, equipment, unclear accountability, demands exceeding individuals' capacity, infection control and task-specific issues. The physical workspace theme accounted for the largest number of critical LST events (n=152). We observed differences in LST events across the four scenarios; complex scenarios had more LST events.

CONCLUSIONS: We identified a diverse set of critical LSTs during trauma resuscitations using ISS coupled with video-based framework analysis. The hazard matrix scoring, in combination with detailed LST subthemes, supported identification of critical LSTs requiring intervention and enhanced efforts intended to improve patient safety. This approach may be useful to others who seek to understand the contributing factors to common LSTs and design interventions to mitigate them.

Medienart:

E-Artikel

Erscheinungsjahr:

2021

Erschienen:

2021

Enthalten in:

Zur Gesamtaufnahme - volume:30

Enthalten in:

BMJ quality & safety - 30(2021), 9 vom: 23. Sept., Seite 739-746

Sprache:

Englisch

Beteiligte Personen:

Petrosoniak, Andrew [VerfasserIn]
Fan, Mark [VerfasserIn]
Hicks, Christopher M [VerfasserIn]
White, Kari [VerfasserIn]
McGowan, Melissa [VerfasserIn]
Campbell, Doug [VerfasserIn]
Trbovich, Patricia [VerfasserIn]

Links:

Volltext

Themen:

Emergency department
Human factors
Journal Article
Quality improvement
Research Support, Non-U.S. Gov't
Simulation

Anmerkungen:

Date Completed 27.10.2021

Date Revised 27.10.2021

published: Print-Electronic

Citation Status MEDLINE

doi:

10.1136/bmjqs-2020-011363

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM316664723