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Using a bespoke database to manage latent safety threats identified through in situ simulation
  1. Benjamin Parish1,2,
  2. Gareth Meredith2,
  3. Lucy French2,
  4. Lewis Connolly,2
  5. Postgraduate Simulation Department, Royal Cornwall Hospital
  1. 1Simulation Department, Postgraduate Centre, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, UK
  2. 2Department of Anaesthesia, Royal Cornwall Hospitals NHS Trust, Truro, UK
  1. Correspondence to Dr Benjamin Parish, Simulation Department, Postgraduate Centre, Royal Cornwall Hospitals NHS Trust, Truro TR1 3LJ, UK; b.parish{at}

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Simulation has garnered success in healthcare through its ability to teach professionals technical and non-technical skills without exposing patients to the novice practitioner.1

In situ simulation takes this teaching technique into the workplace, using the real systems, equipment and workforce. A significant benefit of in situ simulation is the testing of healthcare systems without exposing a patient to indolent risks that have the potential to cause delays and harm. The source of these risks can be related to deficits in training, resources, environment, processes or protocols. These risks can be difficult to identify without a live test of the system.2

The harm from these latent safety threats (LSTs) can be averted if identified through in situ simulation and rectified before a patient is exposed. Research has suggest that in situ simulation is superior in eliciting these LSTs over laboratory-based simulation.3

By identifying safety threats it is possible to demonstrate a quantitative impact on patient safety.

At the Royal Cornwall Hospital, a rural district general trust, we have used a custom-made database to record and manage these LSTs, making it an integral part of our simulation training.


In 2017, the simulation department at Royal Cornwall Hospital designed a database to record and respond to significant LSTs that arise during in situ simulation.

LSTs are identified during a scenario debrief. This is recorded on a paper form, along with details of the simulation, location and …

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  • Collaborators Mr S Harris: Lead Simulation Practitioner, Royal Cornwall Hospital, steve.harris9{at}; Mr K Huddy: Simulation Practitioner, Royal Cornwall Hospital, kieren.huddy{at}

  • Contributors BP: conception of the project, acquisition, analysis and interpretation of data. GM: conception of the database reporting system and acquisition of data. LF and LC: analysis and interpretation of the data. Kieren Huddy and Steve Harris: acquisition of the data. The draft version was produced by BP. All authors were involved in revising the draft and giving approval for it to be published. All authors take responsibility for the accuracy and integrity of the published work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

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