Uncovering success stories: how to resuscitate in situ simulation initiatives in Canadian emergency departments

In situ simulation (ISS) has long been recognized as a powerful tool for identifying latent safety threats, enhancing teamwork, and ultimately improving patient safety in Emergency Departments (EDs). However, the challenges of operationalizing ISS training in the current clinical environment in Canadian EDs have become increasingly evident. While many EDs face hurdles in implementing ISS, some teams have proven resilient and successful in their ISS endeavors. This study aims to determine which factors are associated with the successful maintenance of ISS programs within Canadian EDs. Using a positive deviance approach, we conducted a qualitative study of ED teams engaged in ISS projects, using interviews as a data collection tool. We recruited 14 healthcare providers who had participated in successful ISS initiatives in Canadian EDs. Participants highlighted the importance of engaging interprofessional stakeholders, flexibility from the simulation team, and buy-in from participants and colleagues as key factors contributing to the success of ISS programs. Challenges identified included lack of buy-in, space constraints, high patient volume and acuity, and staff shortages. Strategies for managing these challenges included scheduling simulations during less busy times and having alternative spaces for simulations. ISS was found to have a significant impact on patient safety, improving teamwork, crisis resource management, and overall patient care. These findings provide valuable insights for EDs looking to start or improve their ISS programs, emphasizing the importance of collaboration and adaptability in overcoming challenges to ensure the success of ISS initiatives.