In Situ Simulation: The Potential and Reality

      Next week, our high fidelity simulator and simulation team is heading to our in-hospital located outpatient Pediatric Sleep Lab.  The docket will include pediatric seizure and resuscitation scenarios that are possible in this setting and in their circumstances.  As someone who has used in situ simulation in multiple settings, including operating theaters, emergency departments, medical surgical units and intensive care units for 6 years now, I can tell you that I am always excited by the environmental risks, ergonomic problems, potential safety risks and system problems we uncover every time we begin simulating emergency scenarios in real clinical settings.  We are there for training and assisting this team for emergency preparedness.  I'm proud that where I work at All Children's Hospital Johns Hopkins Medicine, the safety culture is agile and responsive.  As soon as the direct care providers see a defect, they are moving for change immediately.  The safety of children is paramount.  It is a great thing that we have the organization support, expertise and technology to provide this amazing service to our clinicians and patients.  What occurs to me, however, is that the reality of in situ simulation is not a regular feature of all hospitals and systems.  It has not made the leap and the spread to being a regular standard of testing across all hospitals and systems.   Certainly now, simulation is expanding and normalizing in health professional education.  Next, I believe, we should move for simulation to expand as a regular feature of patient safety and quality improvement across all healthcare systems.  I believe this is the reality all clinicians want for their patients. Some discussions that have been held over the last couple years in Congress about patient safety give me hope that hospitals may one day be resourced through reimbursement models.  I'm hopeful that this reality is where our healthcare system is heading.