Developing in situ large-scale simulation strategies for enhanced patient safety

The transition to a new emergency department (ED) facility can pose significant challenges to patient safety. This study utilized Colman et al.'s simulation-based clinical systems testing approach to identify latent safety threats (LSTs), ensure operational readiness, and enhance staff confidence in a newly constructed ED at an urban hospital. A three-stage framework comprising development, implementation, and evaluation phases was employed. A large-scale "day in a life" in situ simulation was conducted to test system integration and identify LSTs. Data from participants, observers, and facilitators were collected and analyzed to develop action plans. The simulation included 63 scenarios over 4 h, engaging 125 participants and 50 standardized patients. A total of 113 LSTs were identified, leading to the development of a detailed action plan. Feedback from staff was positive, with participants reporting increased confidence in providing safe patient care in the new facility. This approach successfully identified safety threats and enhanced staff preparedness, potentially informing future operational plans for transitions in healthcare facilities. The methodology and findings are generalizable to other healthcare facilities undergoing similar transitions, where system integration, safety evaluation, and staff readiness are key concerns.