BACKGROUND: In-situ simulations are effective in identifying latent safety threats. In high-volume elective operating departments, cardiac arrests are rare due to strict patient selection. Implementing in-situ cardiac arrest simulations in these settings is crucial to evaluate adherence to cardiopulmonary resuscitation (CPR) guidelines and enhance patient safety by detecting and managing safety threats. METHOD: From October 2023 to June 2024, a 20-minute in-situ cardiac arrest simulation with debriefing was conducted bi-weekly in a high-volume orthopedic surgery ward with seven operating rooms, without additional staffing. Latent safety threats were identified and addressed. Time to call for help, start of compressions, and first defibrillation was measured, as was airway management choice by anesthesia. Staff confidence was assessed via an anonymous 11-step Likert-scale questionnaire before and after the project, ranging from 0 (no confidence) to 10 (highest confidence). RESULTS: 22 simulations were conducted. Multiple safety improvements were implemented, including role clarification and development of an amiodarone kit. Adherence to cardiopulmonary resuscitation guidelines was strong, achieving time goals in 21 simulations (95%). Anesthesia intubated in 100% of cases when present (16/22, 73%). The questionnaire response rate was 72% (38/53). Staff confidence significantly improved after the project, with median scores increasing from 4.5 to 7.0 (IQR 2.25-7 before, 6-8 after) for personal ability (p <
0.001) and 6.5 to 8.5 (IQR 4-7.25 before, 8-9 after) for team ability (p <
0.001). CONCLUSIONS: A 20-minute in-situ cardiac arrest simulation with debriefing is feasible in a high-volume operating department. Mitigating safety threats and achieving guideline adherence demonstrates functional emergency routines. Staff confidence in managing cardiac arrests significantly increased.