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Study protocol for a framework analysis using video review to identify latent safety threats: trauma resuscitation using in situ simulation team training (TRUST)
  1. Mark Fan1,2,
  2. Andrew Petrosoniak3,4,
  3. Sonia Pinkney2,
  4. Christopher Hicks3,4,
  5. Kari White5,
  6. Ana Paula Siquiera Silva Almeida6,
  7. Douglas Campbell5,7,
  8. Melissa McGowan3,
  9. Alice Gray3,
  10. Patricia Trbovich1,2,8
  1. 1Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
  2. 2HumanEra, University Health Network, Toronto, Ontario, Canada
  3. 3Department of Emergency Medicine, St Michael's Hospital, Toronto, Ontario, Canada
  4. 4Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  5. 5Allan Waters Family Simulation Centre, St Michael's Hospital, Toronto, Ontario, Canada
  6. 6Human Factors and Usability Laboratory, Universidade Federal de Itajubá, Itajubá, Brazil
  7. 7Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
  8. 8Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Mark Fan;{at}


Introduction 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.

Methods and analysis 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.

Ethics and dissemination 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.


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  • Contributors AP and CH designed and led the study. AP, CH and KW led the postscenario debriefs. MF, SP, APSSA and PT performed the framework analysis and inter-rater reliability analysis. AP, CH, KW, AG, MM, and DC validated the scenarios and helped execute the simulations. MF, AP and PT wrote the paper. All authors critically reviewed and edited the paper.

  • Funding This work was supported by grants from the Royal College of Physicians and Surgeons (Medical Education Research Grant), SIM-one/IDEAS/CPSI Simulation for Safety and Quality Improvement Program and St Michael's Hospital AFP Innovation Fund.

  • Disclaimer The funding sources had no role in the design of this study and will not have any role in the study's implementation, data analysis or dissemination of study results.

  • Competing interests None declared.

  • Ethics approval St. Michael's Hospital, Toronto, Ontario, Canada.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement As our manuscript is for a study protocol, and not a completed research study, we have no additional data sets to share at this time.

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