Using tabletop translational simulation to stress test a hospital procedure for neonatal abduction: a system-focused simulation study

Background Neonatal abduction within a hospital is an extremely rare but potentially catastrophic event. Accreditation frameworks such as Joint Commission International (JCI) require hospitals to demonstrate that procedures for such events are not only documented but operationally sustainable. Translational simulation offers a structured method to evaluate the gap between written procedures and real operational capability. This study describes a tabletop translational simulation designed to stress-test the neonatal abduction procedure at Meyer Children’s Hospital IRCCS (Florence, Italy). Methods A descriptive observational study based on a system-oriented tabletop simulation was conducted on 11 November 2025, following the Input–Process–Output framework and the INACSL Healthcare Simulation Standards of Best Practice. Five plausible escape routes were identified and physically walked beforehand to obtain objective escape times, then used as fixed scenario inputs initiated at T0. Participants from neonatal and paediatric intensive care, the hospital non-clinical emergency service, and the hospital internal police were informed of the simulated event two minutes after T0. Data included chronological organisational actions, procedure accessibility, staff allocation, and qualitative feedback from structured responses and debriefing. Results The five escape routes were completed between three and just over six minutes after T0, representing the structural constraints of the environment. The first call to the hospital internal police occurred more than five minutes after notification, and the hospital non-clinical emergency service reached the main exits seven minutes after notification — after all escape routes had already been completed. Contacting the hospital non-clinical emergency service was a spontaneous action not prescribed by the procedure. Intranet retrieval of the procedure required over four minutes in the neonatal unit. Conclusions Tabletop translational simulation proved feasible and informative for evaluating the operational sustainability of a neonatal abduction procedure. The findings reveal a structural temporal gap between escape completion and effective organisational response — a vulnerability that written procedure review alone would be unlikely to detect — and were translated into organisational recommendations to support procedural revision, although the reported timings represent point estimates derived from a single observation rather than distributions and should be interpreted accordingly.