Translational simulation in anaesthesia: a systematic review of applications, processes, outcomes, and implementation factors.

BACKGROUND

Translational simulation is an emerging approach that operationalises simulation as a tool to explore and improve healthcare systems. Anaesthesia represents a well-suited context for translational simulation; however, the applications, processes, outcomes, and factors influencing the implementation of translational simulation in anaesthesia are poorly characterised.

METHODS

MEDLINE, Embase, Scopus, the Cumulative Index to Nursing and Allied Health Literature, and Google Scholar were searched for studies using translational simulation approaches to explore or improve multidisciplinary anaesthetic care. Two independent reviewers performed study selection. Data extraction and risk of bias assessment were performed using Thomas and Harden's approach to inductive qualitative synthesis.

RESULTS

Of 5760 unique citations, 149 were included, involving more than 3300 anaesthesia staff across 37 countries. Most studies used translational simulation to identify latent safety threats and optimise protocols, resulting in structural or procedural modifications in 113 studies. A total of nine process domains, including 90 translational processes, were identified. Applications of translational simulation predominantly focused on crisis management rather than routine perioperative care, and the involvement of conceptual frameworks and contemporary safety sciences (e.g. Safety-II) was infrequent. Although signals of improved patient outcomes were reported, causal attribution remains limited by a predominance of quasi-experimental designs. Implementation relied heavily upon executive sponsorship and integration into clinical governance to overcome workforce and logistical barriers.

CONCLUSIONS

Translational simulation has been widely operationalised in anaesthesia as a pragmatic systems engineering tool. To mature as a scientific discipline, future translational simulation initiatives must adopt standardised nomenclature, explore high-volume routine perioperative care, and transition from ad hoc projects to theory-informed programmes embedded within hospital quality and safety structures.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD420251013645.