In situ Simulation as a Training Tool in a Tertiary Pediatric Emergency Department in Italy: Enhancing Preparedness Where it Matters.

BACKGROUND

In situ simulation differs from in-centre simulation as it is conducted in the actual clinical environment rather than a simulation laboratory, thereby enhancing contextual realism and enabling identification of system-level vulnerabilities within clinical workflows.

OBJECTIVE

To evaluate the impact of in situ simulation on self-perceived competence, clinical performance, team dynamics, and system readiness in a tertiary pediatric emergency department in Italy.

METHODS

This prospective single-center observational study was conducted in a tertiary pediatric emergency department in Italy. A total of 55 healthcare professionals participated in 11 high-fidelity in situ simulation sessions. Participants completed pre- and post-intervention self-assessment questionnaires using a Likert-scale instrument developed for the study. Clinical performance was evaluated using a structured ABCDE-based checklist. No formal qualitative interviews were conducted. Statistical analysis was performed using paired t-tests with a significance threshold of p<0.05.

RESULTS

Significant improvements were observed across all assessed domains, particularly in ABCDE assessment, ventilation, and defibrillator use (p<0.001). Junior residents and participants without recent EPALS certification demonstrated the greatest improvement. In situ simulation also identified latent safety threats related to equipment availability and clinical workflow.

CONCLUSION

In situ simulation improves perceived clinical competence and team performance while providing actionable insights into system-level safety vulnerabilities. Future research should incorporate objective performance metrics and validated assessment tools.