Study protocol for a framework analysis using video review to identify latent safety threats: trauma resuscitation using in situ simulation team training (TRUST).
Errors in trauma resuscitation are common and have been attributed to breakdowns in the coordination of system elements (eg, tools/technology, physical environment and layout, individual skills/knowledge, team interaction). These breakdowns are triggered by unique circumstances and may go unrecognised by trauma team members or hospital administrators; they can be described as latent safety threats (LSTs). Retrospective approaches to identifying LSTs (ie, after they occur) are likely to be incomplete and prone to bias. To date, prospective studies have not used video review as the primary mechanism to identify any and all LSTs in trauma resuscitation.



A series of 12 unannounced in situ simulations (ISS) will be conducted to prospectively identify LSTs at a level 1 Canadian trauma centre (over 800 dedicated trauma team activations annually). 4 scenarios have already been designed as part of this protocol based on 5 recurring themes found in the hospital's mortality and morbidity process. The actual trauma team will be activated to participate in the study. Each simulation will be audio/video recorded from 4 different camera angles and transcribed to conduct a framework analysis. Video reviewers will code the videos deductively based on a priori themes of LSTs identified from the literature, and/or inductively based on the events occurring in the simulation. LSTs will be prioritised to target interventions in future work.



Institutional research ethics approval has been acquired (SMH REB #15-046). Results will be published in peer-reviewed journals and presented at relevant conferences. Findings will also be presented to key institutional stakeholders to inform mitigation strategies for improved patient safety.
Research and Innovation, North York General Hospital, Toronto, Ontario, Canada.|HumanEra, University Health Network, Toronto, Ontario, Canada.
Mark
0000-0001-8194-6794
M
Fan
Department of Emergency Medicine, St Michael's Hospital, Toronto, Ontario, Canada.|Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Andrew
A
Petrosoniak
HumanEra, University Health Network, Toronto, Ontario, Canada.
Sonia
S
Pinkney
Department of Emergency Medicine, St Michael's Hospital, Toronto, Ontario, Canada.|Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Christopher
C
Hicks
Allan Waters Family Simulation Centre, St Michael's Hospital, Toronto, Ontario, Canada.
Kari
K
White
Human Factors and Usability Laboratory, Universidade Federal de Itajubá, Itajubá, Brazil.
Ana Paula Siquiera Silva
AP
Almeida
Allan Waters Family Simulation Centre, St Michael's Hospital, Toronto, Ontario, Canada.|Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
Douglas
D
Campbell
Department of Emergency Medicine, St Michael's Hospital, Toronto, Ontario, Canada.
Melissa
M
McGowan
Department of Emergency Medicine, St Michael's Hospital, Toronto, Ontario, Canada.
Alice
A
Gray
Research and Innovation, North York General Hospital, Toronto, Ontario, Canada.|HumanEra, University Health Network, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Patricia
P
Trbovich
D002983:Clinical Competence; D003142:Communication; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D019300:Medical Errors / Q000517:prevention & control*; D061214:Patient Safety; D011446:Prospective Studies; D012151:Resuscitation / Q000592:standards*; D012308:Risk Management / Q000379:methods*; D000066908:Simulation Training / Q000379:methods; D014741:Video Recording
HUMAN FACTORS; MEDICAL EDUCATION & TRAINING; QUALITATIVE RESEARCH; TRAUMA MANAGEMENT