Sim-SEA: Integrating Significant Event Audit and In Situ Simulation to Support Patient Safety Learning and Organizational Change—A Prospective Single-Center Pilot Study in Pediatric Emergency Care

Background/Objectives: Patient safety depends on healthcare systems’ ability to learn from clinical experience and translate insights into system-level improvement. Significant Event Audit (SEA) is well established but may only partly capture the dynamic, context-dependent nature of clinical performance. Although in situ simulation is increasingly used to explore team performance and system vulnerabilities, its routine integration into formal risk-management pathways remains limited. We developed Sim-SEA, a structured approach embedding in situ simulation within the SEA learning cycle. Methods: Sim-SEA adapted the seven-phase SEA framework to incorporate in situ simulation as a core component. We conducted a 12-month single-center, uncontrolled pre–post pilot study in a tertiary pediatric emergency department, comprising 10 Sim-SEA cycles. Self-perceived competence in technical and non-technical domains was assessed at baseline and immediately after simulation using a 6-item ad hoc questionnaire. A follow-up assessment was conducted among participants who subsequently encountered a real emergency. Participants’ perceptions, system vulnerabilities, and improvement actions were also examined. Results: Fifty-nine physicians, residents, and nurses participated. Self-perceived competence improved significantly from baseline to post-simulation across ABCDE assessment, teamwork, situational awareness, communication, speak-up behavior, and decision-making (all p < 0.01). At follow-up, available for 35/59 participants (59.3%) who subsequently encountered a real emergency, self-perceived scores remained significantly higher than baseline. Implemented changes included workspace reorganization, a cognitive medication aid, and a standard operating procedure for role allocation. Participants reported greater engagement, reflective learning, psychological safety, and awareness of risks and system vulnerabilities. Conclusions: In this single-center, uncontrolled pilot study, Sim-SEA was feasible as a structured method for embedding in situ simulation within clinical risk management and supported potential benefits for self-perceived learning and the identification and development of organizational and environmental improvement actions. Further studies should assess effects on objective competence and patient-safety outcomes.