Identifying and managing latent safety threats though a zone-wide emergency department in-situ multidiscipline simulation program: A quality improvement project


  • Domhnall O Dochartaigh
  • Lisa Ying
  • Kristen Simard
  • Christina Eichorst
  • Alyshah Kaba
  • Lorissa Mews
  • Melissa Chan
  • Taryn Brown
  • Allison Kirkham
  • Warren Ma





Latent safety threats (LSTs) have been defined as system based issues that threaten patient safety that can materialize at any time and were previously unrecognized by healthcare providers, unit directors, or hospital administration. While LSTs such as system deficiencies, equipment failures, training, or conditions predisposing medical errors are frequently reported in the literature, a paucity was noted in the management and mitigation of these threats. The purpose of the translational simulation quality improvement project study was to utilize translational simulations to identify, manage, and mitigate future latent safety threats in our EDs.


In 2017, 18 in-situ inter-professional simulation sessions were conducted at 11 EDs. Following each session, a survey assessment tool, created by the research team, was completed by participants to identify latent safety threats. Findings were shared with site clinical nurse educators and managers to help facilitate institutional follow up. For reporting, latent safety threats were categorized thematically and coded as either (i) resolved, (ii) ongoing, or (iii) not managed. Follow-up with sites was completed 1 year following the simulation.


A total n=158 LSTs were identified. The number and percentage by theme was: staff 48 (30.4%), equipment 41 (25.9%), medications 33 (20.9%), resuscitation resources 24 (15.2%), and information technology (IT) issues 12 (7.6%).Site follow-up identified that 149 LSTs were resolved and ten required ongoing work to manage. No occurrences of a LST ‘not managed’ were identified.


Translation simulation effectively identified latent safety threats and assisted interdisciplinary teams in the creation of a structured plan and systematic follow-up to enhance the health system and patient care. Through use of a threat mitigation strategy all identified threats were addressed while some require ongoing management. 

Author Biographies

Lisa Ying

Resident, University of Alberta, Department of Emergency Medicine

Kristen Simard

Simulation Consultant, eSim, Alberta Health Services, 

Christina Eichorst

Simulation Consultant, eSim, Alberta Health Services

Alyshah Kaba

Provincial Scientific Lead, eSim Provincial Program, Alberta Health Services, Adjunct Assistant Professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary

Lorissa Mews

Department of Emergency Medicine. University of Calgary. 

Melissa Chan

PEM Program Director, Division of Pediatric Emergency Medicine, Department of Pediatrics, University of British Columbia. 

Taryn Brown

Clinical Lecturer, Department of Emergency Medicine, University of Alberta

Allison Kirkham

Deputy Zone Clinical Department Head Emergency Medicine, Assistant Clinical Professor, University of Alberta & Stollery Children’s Hospitals

Warren Ma

Physician Lead IOC, Emergency Medicine, Edmonton Zone, Alberta Health Services


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How to Cite

O Dochartaigh, D., Ying, L., Simard, K., Eichorst, C., Kaba, A., Mews, L., … Ma, W. (2022). Identifying and managing latent safety threats though a zone-wide emergency department in-situ multidiscipline simulation program: A quality improvement project. Canadian Journal of Emergency Nursing, 45(2), 37–46.



Peer Reviewed Articles