SYSTEMATIC REVIEW article
Front. Health Serv.
Sec. Patient Safety
This article is part of the Research TopicThe Evolving Role of Simulation in HealthcareView all 3 articles
The use of healthcare simulation to identify and address latent safety threats: A scoping review
Provisionally accepted
- 1University of Oxford, Oxford, United Kingdom
- 2NHS Education for Scotland, Edinburgh, United Kingdom
- 3University of Staffordshire School of Health Education Policing and Sciences, Stoke-on-Trent, United Kingdom
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Background: Simulation is a well-established tool for clinical education and has been used to uncover latent safety threats (LSTs) in healthcare settings. However, the extent to which systems theory underpins efforts to detect and mitigate LSTs remains unclear.Objective: This scoping review explores how healthcare simulations have been used to identify and address LSTs, with particular attention to the visibility and application of systems theory in study design, implementation, and analysis.Methods: Using PRISMA-ScR, we systematically reviewed studies from 2014-2024 across MEDLINE, EMBASE, and grey literature sources. Studies were included if simulation was used with the primary aim of identifying LSTs. Data extraction focused on definitions of LSTs, approaches used to identify and analyse LSTs, response strategies, and the visibility of systems theory.Sixty-six studies met inclusion criteria. Most (74.2%) used the term "latent safety threat," though definitions varied. Many studies lacked explicit detail on how LSTs were identified (33.3%) or analysed (41.8%). Systems theory was applied with varying visibility: 36.4% showed unclear or no visibility, 43.9% showed partial visibility, and 19.7% showed full visibility. While 80.3% described actions to address LSTs, approaches ranged from one-off fixes to structured quality improvement strategies. Case studies illustrate best practices and opportunities for improvement in theoretical transparency.Conclusions: Simulation is a valuable method for identifying LSTs, but inconsistent application of systems theory and variable methodological transparency limit learning and generalisability. Future research should make theoretical underpinnings explicit, define terminology clearly, and align simulation design with both educational and organisational improvement goals.
Keywords: Healthcare simulation, Patient Safety, Safety risks, system engineering, Latent safety threats, Quality Improvement
Received: 09 Aug 2025; Accepted: 24 Sep 2025.
Copyright: © 2025 Lounsbury, Tomlinson, Wakeling, Bowie and Higham. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Olivia Lounsbury, olivia.lounsbury@ndcn.ox.ac.uk
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