Evaluating the safety and quality of portable x-ray imaging in a new infectious disease biocontainment unit: an in situ simulation and video-reflexive study

Background: During a pre-commissioning inspection of a new biocontainment centre, radiographers noted several structural features of quarantine rooms that could compromise staff and patient safety and the quality of X-rays, even with significant modifications to a previously developed and tested radiography protocol. Methods To evaluate the safety and effectiveness of the existing protocol in the new space, two simulated mobile x-rays were undertaken in the unit prior to commissioning. The simulations were videoed, and participants and other stakeholders collaboratively analysed video footage to identify potential problems and devise solutions. These sessions were audio-recorded, transcribed and analysed thematically. Identified problems and solutions were collated and communicated to the hospital executive, to be endorsed and actioned where possible. Results Seven healthcare workers volunteered to participate. Participants identified serious latent safety threats including: increased risks of exposure to infection, occupational injury and radiation, interference with communication, and X-ray quality. Several unforeseen but important issues, across all four areas of risk, were identified only during facilitated group reviews of video footage. Conclusions In situ simulation is increasingly used to evaluate and improve healthcare practices. This study confirmed the added value of video-reflexive methods, which provide experienced participants with a richer view of a familiar protocol, in a new setting. Video footage can be examined immediately or later, if required, and by a broader group of stakeholders with diverse experience or expertise. Using video-reflexivity, clinicians were able to identify, collate and present latent safety threats to those who could endorse and implement the modifications. Trial registration: Not applicable.