# IN SITU: Evaluation of the feasibility and impacts of in situ simulation in emergency medicine, a mixed method study

## TL;DR

This study evaluates the feasibility and safety of announced and unannounced in situ simulations in emergency medicine, finding both are practical but unannounced simulations are less feasible during a pandemic.

## Contribution

The study compares announced and unannounced in situ simulations in emergency departments, revealing differences in feasibility during a pandemic.

## Key findings

- Both announced and unannounced in situ simulations are safe and practical for emergency medicine.
- Unannounced simulations were less feasible during a pandemic.
- No significant differences in latent safety threats were found between the two simulation types.

## Abstract

In situ simulation (ISS) is a popular teaching method which uses simulated scenarios occurring in the actual clinical work environment of the learners. Our study aimed to compare the feasibility, safety, and identification of latent safety threats (LSTs) of two types of ISS in the Emergency Department (ED): announced and unannounced.

We conducted a mixed method study at a Level-1 trauma center ED, using announced and unannounced ISS sessions. Research Assistants conducted semi-structured individual interviews to measure acceptability, implementation, and practicality. We also assessed implementation and patient safety using quantitative parameters (number of cancelled ISS sessions, ED wait times, patients who left without being seen, latent safety threats). We performed thematic content analyses for the qualitative data. Quantitative data were analysed using descriptive statistics and linear mixed-effects modelling.

In total, 84 emergency professionals participated in 18 simulations; 5 were unannounced and 13 were announced. Three main themes emerged from the interviews: the positive impact of ISS on patient safety, the preference for announced ISS, and the stress induced by ISS. The comparison of safety parameters showed no differences between both ISS modalities except for an increased number of patients leaving without being seen after unannounced ISS.

Our study found that both announced and unannounced in situ simulations are safe and practical for emergency medicine. They do not affect patient safety, or the number of latent safety threats. However, unannounced simulations were less feasible during a pandemic.

The online version contains supplementary material available at 10.1186/s13049-025-01542-9.