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Qualitative analysis of latent safety threats uncovered by in situ simulation-based operations testing before moving into a single-family-room neonatal intensive care unit

Journal of Perinatology volume 40, pages 29–35 (2020)Cite this article

Abstract

Objectives

We aimed to identify: (a) latent safety threats (LSTs) in a new neonatal intensive care unit (NICU) through simulation-based pre-occupancy operations testing, and (b) LSTs that remained unresolved 1-year post-occupancy.

Study design

In this qualitative study, 111 healthcare professionals participated in patient care simulations and debriefings in a new NICU. Debriefing transcripts were inductively analyzed to characterize LSTs. Unresolved LSTs were identified 1 year after NICU occupancy.

Results

Thematic saturation was attained after analysis of nine debriefings. Four major themes affecting staff function and patient safety emerged from 305 threats: relay of information, workplace design, patient care processes, and patient family and staff focus. One-year post occupancy, 29 (9%) LSTs remained unresolved.

Conclusion

Team debriefings of simulated patient events uncover LSTs that can largely be resolved before transitioning patient care into a new NICU. Understanding how LSTs interact provides a platform to develop viable strategies to mitigate patient safety risks.

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Fig. 1: Latent safety events uncovered from in situ team simulations and debriefings.
Fig. 2: Framework illustrating the relationship between different latent safety threat themes and subthemes.

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References

  1. Altimier L, Phillips R. The neonatal integrative developmental care model: advanced clinical applications of the seven core measures for neuroprotective family-centered developmental care. Newborn Infant Nurs Rev. 2016;16:230–44.

    Article  Google Scholar 

  2. White RD. The newborn intensive care unit environment of care: how we got here, where we’re headed, and why. Semin Perinatol. 2011;35:2–7.

    Article  Google Scholar 

  3. Walsh WF, McCullough KL, White RD. Room for improvement: nurses’ perceptions of providing care in a single room newborn intensive care setting. Adv Neonatal Care. 2006;6:261–70.

    Article  Google Scholar 

  4. Domanico R, Davis DK, Coleman F, Davis BO. Documenting the NICU design dilemma: comparative patient progress in open-ward and single family room units. J Perinatol. 2011;31:281–8.

    Article  CAS  Google Scholar 

  5. Lester BM, Hawes K, Abar B, Sullivan M, Miller R, Bigsby R, et al. Single-family room care and neurobehavioral and medical outcomes in preterm infants. Pediatrics. 2014;134:754–60.

    Article  Google Scholar 

  6. Villamaria FJ, Pliego JF, Wehbe-Janek H, Coker N, Rajab MH, Sibbitt S, et al. Using simulation to orient code blue teams to a new hospital facility. Simul Healthc. 2008;3:209–16.

    Article  Google Scholar 

  7. Bender GJ. In situ simulation for systems testing in newly constructed perinatal facilities. Semin Perinatol. 2011;35:80–3.

    Article  Google Scholar 

  8. Knight P, MacGloin H, Lane M, Lofton L, Desai A, Haxby E, et al. Mitigating latent threats identified through an embedded in situ simulation program and their comparison to patient safety incidents: a retrospective review. Front Pediatr. 2017;5:281.

    Article  Google Scholar 

  9. Wetzel EA, Lang TR, Pendergrass TL, Taylor RG, Geis GL. Identification of latent safety threats using high-fidelity simulation-based training with multidisciplinary neonatology teams. Jt Comm J Qual Patient Saf. 2013;39:268–73.

    PubMed  Google Scholar 

  10. Kobayashi L, Shapiro MJ, Sucov A, Woolard R, Boss RM 3rd, Dunbar J, et al. Portable advanced medical simulation for new emergency department testing and orientation. Acad Emerg Med. 2006;13:691–5.

    Article  Google Scholar 

  11. Halamek LP. Editorial: Bringing latent safety threats out into the open. Jt Comm J Qual Patient Saf. 2013;39:267.

    PubMed  Google Scholar 

  12. Adler MD, Mobley BL, Eppich WJ, Lappe M, Green M, Mangold K. Use of simulation to test systems and prepare staff for a new hospital transition. J Patient Saf. 2018;14:143–7.

    Article  Google Scholar 

  13. Wheeler DS, Geis G, Mack EH, LeMaster T, Patterson MD. High-reliability emergency response teams in the hospital: improving quality and safety using in situ simulation training. BMJ Qual Saf. 2013;22:507–14.

    Article  Google Scholar 

  14. Geis GL, Pio B, Pendergrass TL, Moyer MR, Patterson MD. Simulation to assess the safety of new healthcare teams and new facilities. Simul Healthc. 2011;6:125–33.

    Article  Google Scholar 

  15. Bender GJ, Maryman JA. Clinical macrosystem simulation translates between organizations. Simul Healthc. 2018;13:96–106.

    Article  Google Scholar 

  16. Carlson B, Walsh S, Wergin T, Schwarzkopf K, Ecklund S. Challenges in design and transition to a private room model in the neonatal intensive care unit. Adv Neonatal Care. 2006;6:271–80.

    Article  Google Scholar 

  17. Helminski L. Total quality in instruction: a systems approach. In Roberts HV, editor. Academic initiatives in total quality for higher education. Milwaukee, WI: ASQC Quality Press; 1995.

  18. Zigmont JJ, Kappus LJ, Sudikoff SN. The 3D model of debriefing: defusing, discovering, and deepening. Semin Perinatol. 2011;35:52–8.

    Article  Google Scholar 

  19. Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis. Newbury Park, CA: Sage Publishing; 2006.

    Google Scholar 

  20. Corbin JS. Basics of qualitative research: techniques and procedures for developing grounded theory, 3rd ed. Thousand Oaks, CA: Sage Publishing; 2008.

  21. Borkan J. Immersion/crystallization: doing qualitative research, 2nd ed. Thousand Oaks, CA: Sage Pubilications; 1999.

  22. Miles M, Huberman M. Qualitative data analysis: an expanded sourcebook, 2nd ed. Thousand Oaks, CA: Sage Pubilications; 1994.

  23. The Joint Commission. Preventing infant death and injury during delivery. Jt Comm Perspect. 2004;24:14–5.

    Google Scholar 

  24. Keohane CA, Dwyer K, Boulanger J, Zigmont K, Babayan A, Cushing E, et al. Partnering with a medical malpractice insurer to improve patient safety and decrease risk. J Perinat Neonatal Nurs. 2018;32:66–71.

    Article  Google Scholar 

  25. Patterson MD, Geis GL, Falcone RA, LeMaster T, Wears RL. In situ simulation: detection of safety threats and teamwork training in a high risk emergency department. BMJ Qual Saf. 2013;22:468–77.

    Article  Google Scholar 

  26. Braithwaite J, Wears R, Hollnagel E. Resilient health care, volume 3: reconciling work-as-imagined and work-as-done. Boca Raton, FL: CRC Press; 2017.

    Google Scholar 

  27. Reason J. Human error: models and management. BMJ. 2000;320:768–70.

    Article  CAS  Google Scholar 

  28. Agency for Healthcare Research and Quality. Patient safety primer: systems approach. Rockville, MD: AHRQ patient safety network. https://psnet.ahrq.gov/primer/systems-approach. Accessed 21 Oct 2019.

  29. Searl MM, Borgi L, Chemali Z. It is time to talk about people: a human-centered healthcare system. Health Res Policy Syst. 2010;8:35.

    Article  Google Scholar 

  30. Bender J, Shields R, Kennally K. Transportable enhanced simulation technologies for pre-implementation limited operations testing: neonatal intensive care unit. Simul Healthc. 2011;6:204–12.

    Article  Google Scholar 

Download references

Funding

This work was supported in part by the Agency for Healthcare Research and Quality (R18HS023460-01). This article is published as part of a supplement sponsored by Philips.

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA

    Rita Dadiz, Julie Riccio, Kristen Brown & Paula Emrich

  2. Department of Pediatrics, Rush University Medical Center, Chicago, IL, USA

    Beverley Robin

  3. Department of Pediatrics, Mission Hospital, Asheville, NC, USA

    Jesse Bender

  4. Warren Alpert Medical School of Brown University, Providence, RI, USA

    Jesse Bender

Authors
  1. Rita Dadiz
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  2. Julie Riccio
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  3. Kristen Brown
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  4. Paula Emrich
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  5. Beverley Robin
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  6. Jesse Bender
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Contributions

All authors made substantial contributions to the study design, data analysis, and preparation of this paper. They approve this final paper version.

Corresponding author

Correspondence to Rita Dadiz.

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Conflict of interest

KB has received speaker honoraria from Abbott Nutrition. The remaining authors declared no conflict of interest.

Ethical approval

The institutional review board at the University of Rochester Medical Center approved the study and waived written consent.

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Dadiz, R., Riccio, J., Brown, K. et al. Qualitative analysis of latent safety threats uncovered by in situ simulation-based operations testing before moving into a single-family-room neonatal intensive care unit. J Perinatol 40 (Suppl 1), 29–35 (2020). https://doi.org/10.1038/s41372-020-0749-3

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