Malignant Hyperthermia (MH) is a high-risk low frequency event; its critical teams can identify MH and are prepared to handle this emergent situation. Having essential supplies accessible and learning how to promptly treat MH is essential for patient survival. Symptoms such as fever, increased CO2, muscle rigidity, and tachycardia can occur rapidly or within hours of exposure to agents, even if the patient has received the agents previously (Hopkins et al., 2021, Rosenbaum & Rosenberg, 2022). The aim of the project was to identify if the use of MH simulation training as a safety tool would improve staff knowledge, confidence, response rates and performance outcomes. The mixed methods design was implemented over the course of eighteen months, eleven malignant hyperthermia mock simulations were carried out. Simulations were completed for all shifts in four hospital areas the ED, PACU/OR, Medical-Surgical, Same day surgical and Mental Health units. The interprofessional team consisted of frontline staff, educators along with quality and safety participation. Before the simulation, participants were pre-briefed and reviewed the criteria for each event. The simulation team agreed for the need of diverse simulations in each specialty area as patient presentations can be very unique. The simulation scenarios included a patient returning from an ECT treatment, a patient returned after discharge from same day surgery for a Prostate procedure, and a same day Surgery/ OR/PACU patient who experienced a GI procedure. The participants were encouraged to immerse into the environment and identify any policy, safety, or typical workflow gaps. After each of the simulations the teams debriefed and reviewed critical elements to improve patient outcomes. The six pre- and post-Likert scale questionnaire was completed by 159 participants, identified an increase of 82% in staff comfort in recognizing a patient experiences MH, an increase of 95% of staff comfort with finding key critical supplies in the MH cart, an 85% increase in knowledge of the staff treating a patient experiencing MH, along with a 99% increase of the code team recognizing appropriate treatment of a patient experiencing MH. The simulation team also performed time study observations pre and post simulations, the process/policy changes resulted in a decrease average of 63 seconds in response time for the teams’ arrival with MH cart to the scene. Qualitative data included staff feedback “This was very helpful, I have never treated a patient with MH,” “I feel more confident and learned a great deal through the simulations.” In conclusion, including simulation training in hospital process and policy making is a helpful strategy to improve patient outcomes, team performance and enhance patient safety practices. As a result, several policy changes occurred, which will be shared at the event. Providing an opportunity for staff to walk through their current workflows, utilizing simulation in a safe, nonjudgmental environment, allowed safe to speak up for safety before patients are put at risk is critical. Simulation is critical in enhancing patient care and systems to workflows to mitigate risks in new environments.