In-situ simulation

What would you do?

The ability to act quickly and accurately when faced with unexpected situations is critical to patient care. The only way to know how you will react is to practice in your actual environment. Simulations that occur outside of your workplace are unable to address unanticipated issues such as:

What do you do when the defibrillator battery is dead?

  • What do you do when the defibrillator battery is dead?
  • Is the crash cart accessible and fully stocked?
  • Is the monitor visible to those who need to see it?
  • What if the chest tube is not where it´s supposed to be?
  • In-situ simulation

    In-situ simulation training is a team-based training technique conducted on the patient care units using equipment and resources from that unit, and involving actual members of the healthcare team.

    In-situ simulation takes place in the real world environment among teams during their regular work schedule with the goal of making the experience as close to reality as possible. With in-situ simulation, reliability and safety can be improved, especially in high-risk areas.

    Debriefing is key

    In-situ simulation has been found to positively impact healthcare providers’ reactions, changes in safety attitudes, organizational performance, and teamwork. This type of training allows teams to review and reinforce their clinical problem-solving abilities in preparation for a crisis or for low frequency/high acuity events. Structured debriefing that is brief and concise is an essential component of in-situ training.

    Cincinnati Children's Hospital

    Cincinnati Children’s Hospital conducted a study of the impact of in-situ simulation on one of their critical care units. The implementation of in-situ training resulted in the discovery of more than one hundred hidden safety threats that would have otherwise gone unnoticed. Identification of these errors resulted in changes made to reduce the risk of error and improve patient safety.

    In-situ simulations also provided a method to reinforce teamwork behaviours, such as: the use of assertive statements, role clarity, performance of frequent updating, development of a shared mental model, performance of independent double checks of high-risk medicines, and overcoming authority gradients between team members.


    Performed simulations


    Identified latent safety threats


    Different approaches to code alerts


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