An in situ simulation program: a quantitative and qualitative prospective study identifying latent safety threats and examining participant experiences.

Gunhild Kjaergaard-Andersen; Pernille Ibsgaard; Charlotte Paltved; Hanne Irene Jensen

Study

An in situ simulation program: a quantitative and qualitative prospective study identifying latent safety threats and examining participant experiences.

January 20, 2021

Kjaergaard-Andersen G, Ibsgaard P, Paltved C, et al. Int J Health Care Qual. 2021;33(1):mzaa148.

View more articles from the same authors.

Simulation training is used by hospitals to improve patient care. This study describes the experience of one Danish hospital shifting from simulation training at external centers to in situ training. The shift to in situ training identified several latent safety threats (e.g., equipment access, lack of closed-loop communication, out-of-date checklists) and these findings led to practice changes.

PubMed citation

Free full text

Related Resources From the Same Author(s)

Patient safety culture improves during an in situ simulation intervention: a repeated cross-sectional intervention study at two hospital sites.

March 25, 2021

Polypharmacy and potentially inappropriate medication in people with dementia: a nationwide study.

June 13, 2018

Minimising human error in malaria rapid diagnosis: clarity of written instructions and health worker performance.

November 8, 2006

Clinical decision support improves the appropriateness of laboratory test ordering in primary care without increasing diagnostic error: the ELMO cluster randomized trial.

December 2, 2020

Medicines reconciliation in the emergency department: important prescribing discrepancies between the shared medication record and patients' actual use of medication.

March 16, 2022

Critical incidents related to cardiac arrests reported to the Danish Patient Safety Database.

April 7, 2010

Development and validation of a taxonomy of adverse handover events in hospital settings.

February 18, 2015

Analysis of clinical decision support system malfunctions: a case series and survey.

April 13, 2016

Persistent next-day effects of excessive alcohol consumption on laparoscopic surgical performance.

May 4, 2011

Radiologist-initiated double reading of abdominal CT: retrospective analysis of the clinical importance of changes to radiology reports.

August 3, 2016

Misreading injectable medications—causes and solutions: an integrative literature review.

April 29, 2020

Insufficient communication about medication use at the interface between hospital and primary care.

February 28, 2007

Effective strategies to increase reporting of medication errors in hospitals.

January 25, 2006

A multi-facetted patient safety resource--a qualitative interview study on hospital managers' perception of the nurse-led Rapid Response Team.

August 23, 2023

Improving patients' intensive care admission through multidisciplinary simulation-based crisis resource management: a qualitative study.

September 20, 2023

American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update.

February 1, 2017

Association between end-of-rotation resident transition in care and mortality among hospitalized patients.

December 14, 2016

Delayed rapid response team activation is associated with increased hospital mortality, morbidity, and length of stay in a tertiary care institution.

October 28, 2015

Addressing disease-related malnutrition in hospitalized patients: a call for a national goal.

September 30, 2015

Nurses' use of computerized clinical guidelines to improve patient safety in hospitals.

May 6, 2015

Unannounced versus announced hospital surveys: a nationwide cluster-randomized controlled trial.

May 3, 2017

Drug shortages: a complex health care crisis.

May 7, 2014

Evaluating implementation of a rapid response team: considering alternative outcome measures.

May 7, 2014

Tracing the foundations of a conceptual framework for a patient safety ontology.

September 22, 2010

The impact of rapid response team on outcome of patients transferred from the ward to the ICU: a single-center study.

August 28, 2013

Reducing serious safety events and priority hospital-acquired conditions in a pediatric hospital with the implementation of a patient safety program.

June 6, 2018

Exploring physician perspectives of residency holdover handoffs: a qualitative study to understand an increasingly important type of handoff.

August 2, 2017

JAMA professionalism: disclosure of medical error.

August 24, 2016

Addressing delays in medication administration for patients transferred from the hospital to the nursing home: a pilot quality improvement project.

December 10, 2008

The "Big Dog" effect: variability assessing the causes of error in diagnoses of patients with lung cancer.

July 19, 2006

A method for measuring system safety and latent errors associated with pediatric procedural sedation.

July 27, 2005

Frequency and outcome of cervical cancer prevention failures in the United States.

December 19, 2007

Clinical impact and frequency of anatomic pathology errors in cancer diagnoses.

October 26, 2005

Anatomic pathology databases and patient safety.

October 19, 2005

The effect of transitions intervention to ensure patient safety and satisfaction when transferred from hospital to home health care-a systematic review.

March 8, 2023

Comparison of methods to reduce bias from clinical prediction models of postpartum depression.

May 12, 2021

Promoting the psychological well-being of healthcare providers facing the burden of adverse events: a systematic review of second victim support resources.

June 23, 2021

Why an open disclosure procedure is and is not followed after an avoidable adverse event.

September 8, 2021

Key factors for effective implementation of healthcare workers support interventions after patient safety incidents in health organisations: a scoping review.

January 10, 2024

System planning for modern-day Just Culture to mitigate worker distress and second victim response.

November 29, 2023

Physician and nurse well-being and preferred interventions to address burnout in hospital practice: factors associated with turnover, outcomes, and patient safety.

July 19, 2023

Pharmacy leadership amid the pandemic: maintaining patient safety during uncertain times.

September 14, 2022

How different countries respond to adverse events whilst patients' rights are protected.

September 27, 2023

Perceptions and attitudes of pediatricians and families with regard to pediatric medication errors at home.

September 6, 2023

The second victim phenomenon after a clinical error: the design and evaluation of a website to reduce caregivers' emotional responses after a clinical error.

July 12, 2017

Design and testing of the safety agenda mobile app for managing health care managers' patient safety responsibilities.

January 11, 2017

Multi-level analysis of national nursing students' disclosure of patient safety concerns.

December 12, 2018

Robotic dispensing improves patient safety, inventory management, and staff satisfaction in an outpatient hospital pharmacy.

September 12, 2018

Interventions in health organisations to reduce the impact of adverse events in second and third victims.

September 30, 2015

The challenges in monitoring and preventing patient safety incidents for people with intellectual disabilities in NHS acute hospitals: evidence from a mixed-methods study.

October 15, 2014

Risks in the implementation and use of smart pumps in a pediatric intensive care unit: application of the failure mode and effects analysis.

May 21, 2014

Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study.

December 19, 2018

Comparison of methods for identifying patients at risk of medication-related harm.

July 21, 2010

Who do hospital physicians and nurses go to for advice about medications? A social network analysis and examination of prescribing error rates.

April 16, 2014

Using Plan Do Study Act to transform a simulation center.

July 24, 2013

Families as partners in hospital error and adverse event surveillance.

March 8, 2017

Alterations in Spanish language interpretation during pediatric critical care family meetings.

December 6, 2017

Lessons learned for reducing the negative impact of adverse events on patients, health professionals and healthcare organizations.

October 11, 2017

Dispensing error rates in pharmacy: a systematic review and meta-analysis.

March 13, 2024

Risks and medication errors analysis to evaluate the impact of a chemotherapy compounding workflow management system on cancer patients' safety.

February 26, 2020

Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid review and meta-analysis.

May 20, 2020

Adverse events detected by clinical surveillance on an obstetric service.

November 15, 2006

Distractions in the operating room: a survey of the healthcare team.

April 5, 2023

Communication matters when it comes to adverse events: associations of adverse events during implant treatment with patients' communication quality and trust assessments.

March 15, 2023

For children admitted to hospital, what interventions improve medication safety on ward rounds?

March 1, 2023

Missed nursing care during the COVID-19 pandemic: a comparative observational study.

July 21, 2021

Health care workers' experiences of workplace incidents that posed a risk of patient and worker injury: a critical incident technique analysis.

July 14, 2021

COVID-19 and open notes: a new method to enhance patient safety and trust.

July 7, 2021

Purchase of prescription medicines via social media: a survey-based study of prevalence, risk perceptions, and motivations.

October 27, 2021

Medication reconciliation in the geriatric unit: impact on the maintenance of post-hospitalization prescriptions.

October 13, 2021

A program to provide clinicians with feedback on their diagnostic performance in a learning health system.

October 28, 2020

The benefits and harms of open notes in mental health: a Delphi survey of international experts.

December 8, 2021

Overall performance of a drug-drug interaction clinical decision support system: quantitative evaluation and end-user survey.

April 13, 2022

Estimation of breast cancer overdiagnosis in a U.S. breast screening cohort.

March 16, 2022

Unsafe care in residential settings for older adults. A content analysis of accreditation reports.

December 13, 2023

Comparing rates of adverse events detected in incident reporting and the Global Trigger Tool: a systematic review.

August 16, 2023

Exploring everyday work as a dynamic non-event and adaptations to manage safety in intraoperative anaesthesia care: an interview study.

July 26, 2023

Multilevel factors associated with time to biopsy after abnormal screening mammography results by race and ethnicity.

July 6, 2022

Identifying and prioritizing educational content from a malpractice claims database for clinical reasoning education in the vocational training of general practitioners.

October 4, 2023

Do malpractice claim clinical case vignettes enhance diagnostic accuracy and acceptance in clinical reasoning education during GP training?

September 20, 2023

Adolescents identifying errors and omissions in their electronic health records: a national survey.

June 7, 2023

Missed nursing care in the critical care unit, before and during the COVID-19 pandemic: a comparative cross-sectional study.

June 22, 2022

Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.

May 18, 2022

Strengthening open disclosure after incidents in maternity care: a realist synthesis of international research evidence.

April 12, 2023

Development of a pediatric adverse events terminology.

March 15, 2017

Imperfect practice makes perfect: error management training improves transfer of learning.

April 26, 2017

Five topics health care simulation can address to improve patient safety: results from a consensus process.

April 27, 2016

'Even now it makes me angry': health care students' professionalism dilemma narratives.

August 6, 2014

10 years in, why time out still matters.

June 11, 2014

Evaluation and accurate diagnoses of pediatric diseases using artificial intelligence.

February 27, 2019

Understanding the healthcare workplace learning culture through safety and dignity narratives: a UK qualitative study of multiple stakeholders' perspectives.

June 12, 2019

Patients as diagnostic collaborators: sharing visit notes to promote accuracy and safety.

May 22, 2019

Patterns in nursing home medication errors: disproportionality analysis as a novel method to identify quality improvement opportunities.

December 15, 2010

Cleaning up the discharge process: a number of components—and personnel—are crucial to success.

October 20, 2010

Tablet-splitting: a common yet not so innocent practice.

January 19, 2011

Online medication error graphic reports: a pilot in North Carolina nursing homes.

June 15, 2011

Repeat medication errors in nursing homes: contributing factors and their association with patient harm.

July 28, 2010

Novel approach to cardiac alarm management on telemetry units.

February 19, 2014

Miscount incidents: a novel approach to exploring risk factors for unintentionally retained surgical items.

October 2, 2013

Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA.

February 13, 2013

Related Resources

Annual Perspective

Ensuring Patient and Workforce Safety Culture in Healthcare

March 27, 2024

Patient Safety Innovations

Ambulatory Safety Nets to Reduce Missed and Delayed Diagnoses of Cancer

July 31, 2023

Patient Safety Innovations

Remote Response Team and Customized Alert Settings Help Improve Management of Sepsis

May 31, 2023

Annual Perspective

Improving Diagnostic Safety and Quality

April 26, 2023

Crisis scenarios for simulation-based nontechnical skills training for cardiac surgery teams: a national survey among cardiac anesthesiologists, cardiac surgeons, clinical perfusionists, and cardiac operating room nurses.

April 12, 2023

Patient Safety Innovations

The I-READI Quality and Safety Framework: Strong Communications Channels and Effective Practices to Rapidly Update and Implement Clinical Protocols During a Time of Crisis

March 15, 2023

Patient safety culture improves during an in situ simulation intervention: a repeated cross-sectional intervention study at two hospital sites.

March 25, 2021

Awareness of human factors in the operating theatres during the COVID-19 pandemic.

January 13, 2021

Guided reflection interventions show no effect on diagnostic accuracy in medical students.

March 20, 2019

Imperfect practice makes perfect: error management training improves transfer of learning.

April 26, 2017

Simulated settings; powerful arenas for learning patient safety practices and facilitating transference to clinical practice. A mixed method study.

November 16, 2016

Relationship between operating room teamwork, contextual factors, and safety checklist performance.

August 31, 2016

Understanding models of error and how they apply in clinical practice.

July 20, 2016

Reviewing deaths in British and US hospitals: a study of two scales for assessing preventability.

July 20, 2016

Information transfer in multidisciplinary operating room teams: a simulation-based observational study.

May 18, 2016

Five topics health care simulation can address to improve patient safety: results from a consensus process.

April 27, 2016

Aviation tools to improve patient safety.

December 17, 2014

Development and testing of an objective structured clinical exam (OSCE) to assess socio-cultural dimensions of patient safety competency.

December 17, 2014

Blink or think: can further reflection improve initial diagnostic impressions?

November 19, 2014

Patient Safety 2015: Final Technical Report.

November 12, 2014

Assessing distractors and teamwork during surgery: developing an event-based method for direct observation.

October 29, 2014

Development and validation of the Johns Hopkins Disruptive Clinician Behavior Survey.

August 27, 2014

Simulation based adverse event reporting system: development and feasibility.

July 30, 2014

A systematic review of teamwork in the intensive care unit: what do we know about teamwork, team tasks, and improvement strategies?

July 23, 2014

Identification and interference of intraoperative distractions and interruptions in operating rooms.

July 9, 2014

Problem-based training improves recognition of patient hazards by advanced medical students during chart review: a randomized controlled crossover study.

May 7, 2014

Rapid learning of adverse medical event disclosure and apology.

April 9, 2014

Current challenges and future perspectives for patient safety in surgery.

March 12, 2014

Integrating patient safety into health professionals' curricula: a qualitative study of medical, nursing and pharmacy faculty perspectives.

February 19, 2014

What is learning? A review of the safety literature to define learning from incidents, accidents and disasters.

February 19, 2014

See More About The Topic

General Hospitals

Quality and Safety Professionals

Organizational Behaviorists

Safety Scientists

Educators

An in situ simulation program: a quantitative and qualitative prospective study identifying latent safety threats and examining participant experiences.

Ambulatory Safety Nets to Reduce Missed and Delayed Diagnoses of Cancer

Remote Response Team and Customized Alert Settings Help Improve Management of Sepsis

The I-READI Quality and Safety Framework: Strong Communications Channels and Effective Practices to Rapidly Update and Implement Clinical Protocols During a Time of Crisis

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

An in situ simulation program: a quantitative and qualitative prospective study identifying latent safety threats and examining participant experiences.

Ambulatory Safety Nets to Reduce Missed and Delayed Diagnoses of Cancer

Remote Response Team and Customized Alert Settings Help Improve Management of Sepsis

The I-READI Quality and Safety Framework: Strong Communications Channels and Effective Practices to Rapidly Update and Implement Clinical Protocols During a Time of Crisis

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Submit Your Innovations

Continue as a Guest

Continue Logged In

Submit Your Innovations

Continue as a Guest

Continue logged in

New Users to the PSNet site