“The use of in situ simulation as a method for a system check in new facilities allows the identification and subsequent removal of potential safety threats and may prevent critical incidents with real patients” [1].

In situ simulation is defined as a team based training of emergencies in the everyday working environment of the attendees and characterized by the fact that the training takes place in the environment of the patients’ treatment. To identify patient hazard aspects, an in situ simulation draws on the real equipment, real resources and especially on the employees who already work there. Deficiencies in logistic aspects or equipment and potential system based threats for patient safety can be identified through in situ simulation [2, 3, 4, 5, 6, 7, 8]. Another important consideration of this type of simulation is to train the adherence of medical standards and non- technical skills such as communication aspects, teamwork or the decision-making process. In situ simulation can also positively affect the work satisfaction and the attendees’ self-confidence [9, 10].

This form of simulation is especially useful when training medical staff for emergencies in the context of new facilities [8, 10, 5]. Using new facilities and implementing new processes there is always based on anticipated aspects. However, these aspects can differ from the ones identified during the training. Thus, the risk of unknown factors is assigned an important role in the context of readjustment or adaptation of clinical systems, e.g. the optimization of the team composition [8, 10, 11].

An important aspect of risk management are simulations of the expected processes of patient care in newly built or rebuilt clinical facilities to guarantee their immediate and well-adjusted functionality [12]. Therefore, in situ simulation with multiple scenarios in different wards was a convenient instrument for the system check of a new clinic at the LMU Hospital in Munich before the opening in June 2021. Employees from different specialities participated in in situ simulations in the new facilities. Each in situ simulation contained several different clinical scenarios to reflect the real situation at its best. All interventions were conducted in real time with a manikin. Not only the real setting was important for the benefit of in situ simulation, but also administrative processes like the patient registration, the preparation of medical reports, the transport of laboratory samples or communication paths like the involvement of other colleagues. In situ simulations were observed by CRM trainers and recorded in sound and vision. After each scenario, a debriefing was conducted to recap the training and assess the obtained insights. For the opening of these new facilities, in situ simulations helped us to identify potential risks for patient safety regarding equipment, room arrangement or the team composition. Based on these insights, we were able to modify the conditions for the employees and the future patients before opening the new facilities and thus reduce patient risk while at the same time increase the efficiency of the procedures.

In summary, system checks before the opening of new facilities in clinical contexts based on in situ simulation are a convincing method to reveal potential risk sources, have a great impact on staff preparation, and increase patient safety. Insights from previous system checks might already be a valuable input for the planning of new clinical facilities. In situ simulation of the medical staff prior to the opening of a new facility is very valuable for all future patients.

Written by Selina Kim and Dr. Marc Lazarovici, LMU Munich

  1. Keil J, Sandmeyer B, Urban B et al (2015) Testlauf nach Umbau der Kinderintensivstation. Systemcheck durch Simulationstraining. Monatsschr Kinderheilkd
  2. Kobayashi L, Patterson MD, Overly FL et al (2008) Educational and research implications of portable human patient simulation in acute care medicine. Acad Emerg Med 15:1166–1174
  3. MFiller K, Riley W, Davis S (2009) Identifying key nursing and team behaviours to achieve high reliability. J Nurs Manag 17:247–255
  4. Nunnink L, Welsh AM, Abbey M et al (2009) In situ simulation-based team training for post-cardiac surgical emergency chest reopen in the intensive care unit. Anaesth Intensive Care 37:74–78
  5. Patterson MD, Geis GL, Falcone RA et al (2013) In situ simulation: detection of safety threats and teamwork training in a high risk emergency department. BMJ Qual Saf 22:468–477
  6. Weinstock PH, Kappus LJ, Garden A et al (2009) Simulation at the point of care: reduced-cost, in situ training via a mobile cart. Pediatr Crit Care Med 10:176–181
  7. Alfredsdottir H, Bjornsdottir K (2008) Nursing and patient safety in the operating room. J Adv Nurs 61:29–37
  8. Geis GL, Pio B, Pendergrass TL et al (2011) Simulation to assess the safety of new healthcare teams and new facilities. Simul Healthc 6:125–133
  9. Gardner AK, Ahmed RA, George RL et al (2013) In situ simulation to assess workplace attitudes and effectiveness in a new facility. Simul Healthc 8:351–358
  10. Kobayashi L, Shapiro MJ, Sucov A et al (2006) Portable advanced medical simulation for new emergency department testing and orientation. Acad Emerg Med 13:691–695
  11. Wachter RM, Shojania KG (2000) The unintended consequences of measuring quality on the quality of medical care. N Engl J Med 342:520
  12. Graff L, Stevens C, Spaite D et al (2002) Measuring and improving quality in emergency medicine. Acad Emerg Med 9:1091–1107