Patient Elopement (PE) incidents can increase patient safety risks for our vulnerable populations (Marlett, J., Vacovsky, B., Krug, E., Ha-Johnson, T., & Fisher Hill, S., 2023). Traditionally tabletops have been utilized for mass casualty incidents, this is a new innovative for PE simulations. An interprofessional teams dive deep into PE focused on identifying root causes and mitigation solutions to prevent future elopements and reduce patient harm. The team looked to incorporate innovative solutions for simulation education due to time constraints, staffing and fiscal resources available. The project aim, Will the use of tabletop simulations improve staff knowledge, critical judgement and reduce PE incidents. The team developed several tabletop scenarios aimed at Patient Elopement (PE) and identifying use of “Tele sitter/s” for management of care. Due to the unique nature of the project the team opted for a qualitative observation method and retrospective chart reviews for data gathering. Participants included medical-surgical staff to generate critical judgement along with process and policy discussions. The tabletop board was on wheels and measured 36X30, the team utilized “FLAT STANLEYS” to simulate patients and movements with dry erase markers. There were eight rooms/patients with individual diagnoses. Challenging staff to multitask, with different scenarios and to prioritize care plans, critical thinking and clinical judgment and communication based on situations occurring, discuss the WHYS of their decisions. Focusing on timely identification of At-Risk patients and implementation of additional safety precautions (i.e. monitoring devices, colored pajamas, bed alarm, in conjunction with tele sitting, if applicable). During debriefing, participants were able to reflect on decisions and review current policy to identify any performance gaps. Over 190 staff participated in the tabletop simulation. The objectives included increased knowledge, demonstrating, and implementing safety measures and competence to identify at-risk patient scenarios using critical thinking skills and clinical judgement in a verbalized and simulated high-pressure situation. Participants engaged in role-playing exercises were able to effectively communicate procedure/processes involving high-risk patients at risk for Patient Elopement. Pre-study data recognized that 30% of staff did not notify team members when a patient had left their room, 30% lacked awareness that patient was at high-risk for PE and 40% of communications lacked appropriate assessments to determine the patient was at high-risk for PE. During the tabletop staff were assessed utilizing a competency assessment tool, and the four in-depth objectives were met by over 90% of all participants. To date there have been zero patient safety reports related to PE. Qualitative data included staff feedback “I enjoyed this training,” “I have never participated in this type of training, it was an innovative tool,” “I Iearned a lot, it was engaging and very much like real life decisions.” In conclusion, including tabletop simulation training for Patient Elopement (PE) to strengthen hospital processes and policy is a critical strategy to improve patient outcomes, team performance and enhance patient safety practices. The zero events of PE to date highlight the success of the training program.