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0179 ‘In situ’ simulation: testing the system and environment for patient safety in a new renal satellite unit prior to opening
  1. Julie Hannah,
  2. Michael Canavan
  1. NHS Ayrshire And Arran, East Ayrshire, UK


Patient safety is an essential property of the entire healthcare system. The reality is that organisations are not always the safe havens that they should be. We hypothesised that the opening of a new renal dialysis satellite unit in NHS Ayrshire and Arran could inadvertently align gaps in the system leading to potential harm1. We used ‘in situ’ simulation prior to the unit opening to test this theory to identify safety concerns in relation to equipment and environment. The findings were then addressed to ‘build defences to mitigate error’.2

Method We used a Laerdal wireless simulator and an iPad to ‘crash test’ the new unit. A cardiac arrest scenario was scripted with the main objectives as follows:

  • To test the hospital 2222 response

  • To test access and egress to the unit for the cardiac arrest team members

  • To test the emergency equipment was fit for purpose

  • To test the ergonomics for the transfer of a deteriorating patient to the distant intensive care unit

Results The exercise highlighted the following latent threats to patient safety:

  • Inadequate signage

  • Unacceptable delay in arrival of cardiac arrest (CA) team

  • CA team were unaware of the code for the lift

  • CA team swipe ID badges negated access to the stairwell

  • Restricted transfer of simulated patient through corridors

Outcomes A report was prepared and presented to clinical governance. An emergency project group was established to address the aforementioned issues prior to opening of the unit. Future planning includes further ‘in situ’ simulation to test the modifications and to provide an opportunity for team training.

Conclusions This project highlights the value of in situ simulation as a means to prepare staff and identify potential threats to patient safety in a new clinical area prior to any patient throughput.3


  1. Patterson MD, Geis GL, Falcone RA, et al. In situ simulation: detection of safety emergency department threats and teamwork training in a high risk. BMJ Qual Saf 2012; doi: 10.1136/bmjqs-2012-000942

  2. Reason J. Human error: models and management. BMJ 2000;320:768–70

  3. Walker ST, Sevdalis N, McKay A et al. Unannounced in situ simulations: integrating training and clinical practice. BMJ Qual Saf 2012; doi10.1136/bmjqs-2012-000986

  • Category: Course or curriculum evaluation/innovation/integration

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