In situ simulation can identify latent safety threats (LSTs) before they result in patient harm.

This article describes the Translational Work Integrating Simulation and Systems Testing (TWISST) process, which combines simulation-based clinical systems testing (SbCST) and simulation-based training (SbT) to identify and evaluate process improvement opportunities. Between July and November 2019, clinicians, healthcare workers, and simulation educators from one pediatric emergency department (PED) participated in the SbCST process. The SbCST simulation scenario represented a patient with hypotensive shock, progressive respiratory failure requiring intubation, and subsequent cardiac arrest. After the simulated medical emergency, participants engaged in a facilitator-led debriefing process and were asked to identify LSTs and active failures as well as potential solutions. These potential solutions were tested and refined in subsequent simulations before being incorporated into larger SbT workshops.

The SbCST process identified 41 LSTs. Seventeen percent of these were considered ‘high’ or ‘very high’ priority conditions, such as lack of standardized preparation for intubation, lack of available respiratory supplies in the trauma bay, and lack of space for medication preparation. Solutions to these conditions (as well as medium and low priority conditions) were incorporated into process improvements and into the SbT.