Use of in-situ simulation to investigate latent safety threats prior to opening a new emergency department

Abstract

IntroductionThe opening of a new emergency department creates numerous unknowns that can become latent safety threats (LSTs) to patient welfare. Healthcare providers can also experience increased stress working in a novel environment, which has been shown to negatively affect decision making, teamwork, and ultimately patient safety. MethodsIn order to identify LSTs and orient staff, multidisciplinary teams participated in 15 in-situ simulations followed by focused debriefing sessions that stressed uncovering LSTs prior to the ED’s opening. Participants also received an electronic, de-identified survey requesting feedback and recollection of any additional LSTs not mentioned during the debriefing. Staff members were then sent the NASA-Task Load Index questionnaire during the first week of opening, which focused on the staff members stress level. ResultsOver 100 healthcare workers of various disciplines participated in 15 in-situ simulations over the course of one day. Thirty-five LSTs were identified and modified before the opening of the new emergency department. The majority (93%) of participants felt that simulations helped them orient to the new space. While the absolute level of stress was the same between cohorts, irritation and discouragement were 16% less in the group completing the simulation. DiscussionIn-situ simulations performed prior to the opening of a new emergency department identified 35 modifiable latent safety threats. Simulations were an effective way to orient staff to the new space and seemed to decrease the level of discouragement and irritation of healthcare workers during the first few weeks of the emergency department’s opening.