diff --git a/simulator/README.md b/simulator/README.md
index c9906f7..0432abe 100644
--- a/simulator/README.md
+++ b/simulator/README.md
@@ -42,6 +42,9 @@ INFLUXDB_URL=http://localhost:8086
 INFLUXDB_TOKEN=tasks-token-secret
 INFLUXDB_ORG=tasks
 INFLUXDB_BUCKET=audit
+SIMULATOR_INITIAL_MIN_PATIENTS=25
+SIMULATOR_LOOP_SLEEP_SECONDS_MIN=0.12
+SIMULATOR_LOOP_SLEEP_SECONDS_MAX=0.45
 ```
 
 ### Authentication Modes
@@ -110,16 +113,16 @@ The simulator is split into multiple modules:
    - Non-Interactive: Direct Grant flow (if USE_DIRECT_GRANT=true and USERNAME/PASSWORD are set) - no browser required
 2. Loads current state (locations, patients, tasks, users)
 3. Displays the location structure hierarchy
-4. Creates initial patients (some in waiting room, some admitted)
-5. Continuously performs random actions:
-   - Create tasks (25%)
-   - Update tasks (20%)
-   - Create patients (15%)
-   - Admit patients (10%)
-   - Move patients (10%)
-   - Update positions (8%)
-   - Discharge patients (7%)
-   - Add teams (5%)
+4. Seeds at least `SIMULATOR_INITIAL_MIN_PATIENTS` patients (default 25; some waiting, some admitted), each with diagnosis-based treatment tasks
+5. Continuously performs random actions (approximate weights):
+   - Create tasks (32%)
+   - Update tasks (18%)
+   - Create patients (28%)
+   - Admit patients (6%)
+   - Move patients (6%)
+   - Update positions (4%)
+   - Discharge patients (3%)
+   - Add teams (3%)
 
 ## Diagnosis Types
 
diff --git a/simulator/config.py b/simulator/config.py
index 5fceb91..ce96a81 100644
--- a/simulator/config.py
+++ b/simulator/config.py
@@ -14,6 +14,29 @@
 USERNAME = os.getenv("USERNAME", "test")
 PASSWORD = os.getenv("PASSWORD", "test")
 
+
+def _env_int(key: str, default: int) -> int:
+    raw = os.getenv(key)
+    if raw is None or raw.strip() == "":
+        return default
+    return int(raw)
+
+
+def _env_float(key: str, default: float) -> float:
+    raw = os.getenv(key)
+    if raw is None or raw.strip() == "":
+        return default
+    return float(raw)
+
+
+SIMULATOR_INITIAL_MIN_PATIENTS = _env_int("SIMULATOR_INITIAL_MIN_PATIENTS", 25)
+_loop_sleep_min = _env_float("SIMULATOR_LOOP_SLEEP_SECONDS_MIN", 0.12)
+_loop_sleep_max = _env_float("SIMULATOR_LOOP_SLEEP_SECONDS_MAX", 0.45)
+if _loop_sleep_min > _loop_sleep_max:
+    _loop_sleep_min, _loop_sleep_max = _loop_sleep_max, _loop_sleep_min
+SIMULATOR_LOOP_SLEEP_SECONDS_MIN = _loop_sleep_min
+SIMULATOR_LOOP_SLEEP_SECONDS_MAX = _loop_sleep_max
+
 CALLBACK_PORT = 8999
 REDIRECT_URI = f"http://localhost:{CALLBACK_PORT}/callback"
 
diff --git a/simulator/simulator.py b/simulator/simulator.py
index 0fc8069..af3bb7f 100644
--- a/simulator/simulator.py
+++ b/simulator/simulator.py
@@ -1,6 +1,11 @@
 from typing import Optional
 from graphql_client import GraphQLClient
-from config import logger
+from config import (
+    SIMULATOR_INITIAL_MIN_PATIENTS,
+    SIMULATOR_LOOP_SLEEP_SECONDS_MAX,
+    SIMULATOR_LOOP_SLEEP_SECONDS_MIN,
+    logger,
+)
 from location_manager import LocationManager
 from patient_manager import PatientManager
 from task_manager import TaskManager
@@ -55,8 +60,10 @@ def run(self) -> None:
         self.location_manager.ensure_hospital_structure()
         self.location_manager.print_structure()
 
-        logger.info("Creating initial patients...")
-        while len(self.patient_manager.patient_ids) < 5:
+        logger.info(
+            f"Creating initial patients (target at least {SIMULATOR_INITIAL_MIN_PATIENTS})...",
+        )
+        while len(self.patient_manager.patient_ids) < SIMULATOR_INITIAL_MIN_PATIENTS:
             admit_directly = random.random() < 0.4
             patient_id, diagnosis = self.patient_manager.create_patient(
                 admit_directly=admit_directly
@@ -68,14 +75,14 @@ def run(self) -> None:
         logger.info("Starting continuous simulation loop...")
 
         actions = [
-            (self._action_create_task, 0.25),
-            (self._action_update_task, 0.20),
-            (self._action_create_patient, 0.15),
-            (self._action_admit_patient, 0.10),
-            (self._action_move_patient, 0.10),
-            (self._action_update_position, 0.08),
-            (self._action_discharge_patient, 0.07),
-            (self._action_add_team, 0.05),
+            (self._action_create_task, 0.32),
+            (self._action_update_task, 0.18),
+            (self._action_create_patient, 0.28),
+            (self._action_admit_patient, 0.06),
+            (self._action_move_patient, 0.06),
+            (self._action_update_position, 0.04),
+            (self._action_discharge_patient, 0.03),
+            (self._action_add_team, 0.03),
         ]
 
         while True:
@@ -86,7 +93,12 @@ def run(self) -> None:
                 )[0]
 
                 func()
-                time.sleep(random.uniform(2.0, 5.0))
+                time.sleep(
+                    random.uniform(
+                        SIMULATOR_LOOP_SLEEP_SECONDS_MIN,
+                        SIMULATOR_LOOP_SLEEP_SECONDS_MAX,
+                    ),
+                )
 
             except KeyboardInterrupt:
                 logger.info("Simulation stopped by user.")
diff --git a/web/components/patients/LoadTaskPresetDialog.tsx b/web/components/patients/LoadTaskPresetDialog.tsx
index 68e33dc..4c78a51 100644
--- a/web/components/patients/LoadTaskPresetDialog.tsx
+++ b/web/components/patients/LoadTaskPresetDialog.tsx
@@ -14,6 +14,7 @@ import { useApplyTaskGraph, useTaskPresets } from '@/data'
 import { GetPatientDocument, type TaskPresetsQuery } from '@/api/gql/generated'
 import { useSystemSuggestionTasks } from '@/context/SystemSuggestionTasksContext'
 import { presetGraphToTaskGraphInput } from '@/utils/taskGraph'
+import type { PatientDetailListSuccessHint } from '@/components/patients/patientDetailListHint'
 
 type PresetRow = TaskPresetsQuery['taskPresets'][number]
 
@@ -21,7 +22,7 @@ type LoadTaskPresetDialogProps = {
   isOpen: boolean,
   onClose: () => void,
   patientId: string,
-  onSuccess?: () => void,
+  onSuccess?: (hint?: PatientDetailListSuccessHint) => void,
 }
 
 export function LoadTaskPresetDialog({
@@ -110,7 +111,7 @@ export function LoadTaskPresetDialog({
       showToast(translation('tasksCreatedFromPreset'))
       setConfirmOpen(false)
       onClose()
-      onSuccess?.()
+      onSuccess?.({ needsPatientListRefetch: true })
     },
     [
       applyTaskGraph,
diff --git a/web/components/patients/PatientDataEditor.tsx b/web/components/patients/PatientDataEditor.tsx
index ff1d39f..1743d17 100644
--- a/web/components/patients/PatientDataEditor.tsx
+++ b/web/components/patients/PatientDataEditor.tsx
@@ -9,6 +9,7 @@ import { useLocations, usePatient } from '@/data'
 import { Building2, CheckIcon, Locate, PlusIcon, Users, XIcon } from 'lucide-react'
 import { formatLocationPath, formatLocationPathFromId } from '@/utils/location'
 import { toISODate } from './PatientDetailView'
+import type { PatientDetailListSuccessHint } from './patientDetailListHint'
 import { LocationSelectionDialog } from '@/components/locations/LocationSelectionDialog'
 import {
   useCreatePatient,
@@ -34,7 +35,7 @@ type PatientFormValues = Omit<CreatePatientInput, 'clinicId' | 'teamIds' | 'posi
 interface PatientDataEditorProps {
   id: null | string,
   initialCreateData?: Partial<CreatePatientInput>,
-  onSuccess?: () => void,
+  onSuccess?: (hint?: PatientDetailListSuccessHint) => void,
   onClose?: () => void,
   onCreateDraftDirtyChange?: (dirty: boolean) => void,
 }
@@ -136,7 +137,7 @@ export const PatientDataEditor = ({
         variables: { data },
         onCompleted: () => {
           onCreateDraftDirtyChange?.(false)
-          onSuccess?.()
+          onSuccess?.({ needsPatientListRefetch: true })
           onClose?.()
         },
         onError: (error) => {
@@ -203,9 +204,10 @@ export const PatientDataEditor = ({
       const samePosition = (data.positionId ?? current.position?.id) === current.position?.id
       const sameDescription = (data.description ?? current.description ?? '') === (current.description ?? '')
       if (sameFirstname && sameLastname && sameBirthdate && sameSex && sameAssignedIds && sameClinic && sameTeamIds && samePosition && sameDescription) return
+      const needsPatientListRefetch = !sameClinic || !sameTeamIds || !samePosition || !sameAssignedIds
       updatePatient({
         variables: { id: patientId, data },
-        onCompleted: () => onSuccess?.(),
+        onCompleted: () => onSuccess?.({ needsPatientListRefetch }),
       })
     }
   })
@@ -412,7 +414,7 @@ export const PatientDataEditor = ({
                 <div className="flex gap-4 flex-wrap">
                   <Button
                     disabled={value === PatientState.Admitted}
-                    onClick={() => admitPatient({ variables: { id: patientId! }, onCompleted: () => onSuccess?.() })}
+                    onClick={() => admitPatient({ variables: { id: patientId! }, onCompleted: () => onSuccess?.({ needsPatientListRefetch: true }) })}
                     color={value === PatientState.Admitted ? 'positive' : 'neutral'}
                   >
                     <Visibility isVisible={value === PatientState.Admitted}>
@@ -432,7 +434,7 @@ export const PatientDataEditor = ({
                   </Button>
                   <Button
                     disabled={value === PatientState.Wait}
-                    onClick={() => waitPatient({ variables: { id: patientId! }, onCompleted: () => onSuccess?.() })}
+                    onClick={() => waitPatient({ variables: { id: patientId! }, onCompleted: () => onSuccess?.({ needsPatientListRefetch: true }) })}
                     color={value === PatientState.Wait ? 'warning' : 'neutral'}
                   >
                     <Visibility isVisible={value === PatientState.Admitted}>
@@ -605,7 +607,7 @@ export const PatientDataEditor = ({
           onCancel={() => setIsMarkDeadDialogOpen(false)}
           onConfirm={() => {
             if (patientId && markPatientDead) {
-              markPatientDead({ variables: { id: patientId }, onCompleted: () => onSuccess?.() })
+              markPatientDead({ variables: { id: patientId }, onCompleted: () => onSuccess?.({ needsPatientListRefetch: true }) })
             }
             setIsMarkDeadDialogOpen(false)
           }}
@@ -619,7 +621,7 @@ export const PatientDataEditor = ({
           onCancel={() => setIsDischargeDialogOpen(false)}
           onConfirm={() => {
             if (patientId && dischargePatient) {
-              dischargePatient({ variables: { id: patientId }, onCompleted: () => onSuccess?.() })
+              dischargePatient({ variables: { id: patientId }, onCompleted: () => onSuccess?.({ needsPatientListRefetch: true }) })
             }
             setIsDischargeDialogOpen(false)
           }}
@@ -636,7 +638,7 @@ export const PatientDataEditor = ({
               deletePatient({
                 variables: { id: patientId },
                 onCompleted: () => {
-                  onSuccess?.()
+                  onSuccess?.({ needsPatientListRefetch: true })
                   onClose?.()
                 },
               })
diff --git a/web/components/patients/PatientDetailView.tsx b/web/components/patients/PatientDetailView.tsx
index a8e9124..e048d3d 100644
--- a/web/components/patients/PatientDetailView.tsx
+++ b/web/components/patients/PatientDetailView.tsx
@@ -15,6 +15,7 @@ import { PatientStateChip } from '@/components/patients/PatientStateChip'
 import { LocationChips } from '@/components/locations/LocationChips'
 import { PatientTasksView } from './PatientTasksView'
 import { PatientDataEditor } from './PatientDataEditor'
+import type { PatientDetailListSuccessHint } from './patientDetailListHint'
 import { AuditLogTimeline } from '@/components/AuditLogTimeline'
 import { PropertyList, type PropertyValue } from '../tables/PropertyList'
 import { useUpdatePatient } from '@/data'
@@ -50,7 +51,7 @@ export const localToUTCWithSameTime = (d: Date | null | undefined): Date | null
 interface PatientDetailViewProps {
   patientId?: string,
   onClose: () => void,
-  onSuccess: () => void,
+  onSuccess?: (hint?: PatientDetailListSuccessHint) => void,
   initialCreateData?: Partial<CreatePatientInput>,
   onOpenSystemSuggestion?: (suggestion: SystemSuggestion, patientName: string) => void,
   onCreateDraftDirtyChange?: (dirty: boolean) => void,
@@ -128,7 +129,7 @@ export const PatientDetailView = ({
           properties: propertyInputs,
         },
       },
-      onCompleted: () => onSuccess(),
+      onCompleted: () => onSuccess?.({ needsPatientListRefetch: false }),
     })
   }, [isEditMode, patientId, patientData, convertPropertyValueToInput, updatePatient, onSuccess])
 
diff --git a/web/components/patients/PatientTasksView.tsx b/web/components/patients/PatientTasksView.tsx
index 1a78fae..31b40d1 100644
--- a/web/components/patients/PatientTasksView.tsx
+++ b/web/components/patients/PatientTasksView.tsx
@@ -8,11 +8,12 @@ import type { GetPatientQuery } from '@/api/gql/generated'
 import { TaskDetailView } from '@/components/tasks/TaskDetailView'
 import { useCompleteTask, useReopenTask } from '@/data'
 import { LoadTaskPresetDialog } from '@/components/patients/LoadTaskPresetDialog'
+import type { PatientDetailListSuccessHint } from '@/components/patients/patientDetailListHint'
 
 interface PatientTasksViewProps {
   patientId: string,
   patientData: GetPatientQuery | undefined,
-  onSuccess?: () => void,
+  onSuccess?: (hint?: PatientDetailListSuccessHint) => void,
 }
 
 const sortByDueDate = <T extends { dueDate?: string | Date | null }>(tasks: T[]): T[] => {
@@ -63,7 +64,7 @@ export const PatientTasksView = ({
     if (done) {
       completeTask({
         variables: { id: taskId },
-        onCompleted: () => onSuccess?.(),
+        onCompleted: () => onSuccess?.({ needsPatientListRefetch: true }),
         onError: () => {
           setOptimisticTaskUpdates(prev => {
             const next = new Map(prev)
@@ -75,7 +76,7 @@ export const PatientTasksView = ({
     } else {
       reopenTask({
         variables: { id: taskId },
-        onCompleted: () => onSuccess?.(),
+        onCompleted: () => onSuccess?.({ needsPatientListRefetch: true }),
         onError: () => {
           setOptimisticTaskUpdates(prev => {
             const next = new Map(prev)
@@ -190,7 +191,7 @@ export const PatientTasksView = ({
           initialPatientId={isCreatingTask ? patientId : undefined}
           initialPatientName={isCreatingTask ? initialPatientName : undefined}
           onListSync={() => {
-            onSuccess?.()
+            onSuccess?.({ needsPatientListRefetch: true })
           }}
           onClose={() => {
             setTaskId(null)
diff --git a/web/components/patients/patientDetailListHint.ts b/web/components/patients/patientDetailListHint.ts
new file mode 100644
index 0000000..5afd655
--- /dev/null
+++ b/web/components/patients/patientDetailListHint.ts
@@ -0,0 +1,3 @@
+export type PatientDetailListSuccessHint = {
+  needsPatientListRefetch: boolean,
+}
diff --git a/web/components/tables/PatientList.tsx b/web/components/tables/PatientList.tsx
index 393988a..0a93546 100644
--- a/web/components/tables/PatientList.tsx
+++ b/web/components/tables/PatientList.tsx
@@ -8,6 +8,7 @@ import type { LocationType } from '@/api/gql/generated'
 import { Sex, PatientState, type GetPatientsQuery, type TaskType, PropertyEntity, FieldType, type QueryableField } from '@/api/gql/generated'
 import { usePropertyDefinitions, usePatientsPaginated, useQueryableFields, useRefreshingEntityIds } from '@/data'
 import { PatientDetailView } from '@/components/patients/PatientDetailView'
+import type { PatientDetailListSuccessHint } from '@/components/patients/patientDetailListHint'
 import { LocationChips } from '@/components/locations/LocationChips'
 import { LocationChipsBySetting } from '@/components/patients/LocationChipsBySetting'
 import { PatientStateChip } from '@/components/patients/PatientStateChip'
@@ -1119,9 +1120,12 @@ export const PatientList = forwardRef<PatientListRef, PatientListProps>(({ initi
           <PatientDetailView
             patientId={selectedPatient?.id ?? openedPatientId ?? undefined}
             onClose={closePatientDrawer}
-            onSuccess={() => {
-              embeddedOnRefetch?.()
-              void refetch()
+            onSuccess={(hint?: PatientDetailListSuccessHint) => {
+              const needsRefetch = hint?.needsPatientListRefetch ?? true
+              if (needsRefetch) {
+                embeddedOnRefetch?.()
+                void refetch()
+              }
               onPatientUpdated?.()
             }}
             onOpenSystemSuggestion={openSuggestionModal}
diff --git a/web/components/tables/TaskList.tsx b/web/components/tables/TaskList.tsx
index be6f1c7..90c7d24 100644
--- a/web/components/tables/TaskList.tsx
+++ b/web/components/tables/TaskList.tsx
@@ -14,6 +14,7 @@ import { Drawer } from '@helpwave/hightide'
 import { TaskDetailView } from '@/components/tasks/TaskDetailView'
 import { AvatarStatusComponent } from '@/components/AvatarStatusComponent'
 import { PatientDetailView } from '@/components/patients/PatientDetailView'
+import type { PatientDetailListSuccessHint } from '@/components/patients/patientDetailListHint'
 import { useTasksTranslation } from '@/i18n/useTasksTranslation'
 import { useTasksContext } from '@/hooks/useTasksContext'
 import { UserInfoPopup } from '@/components/UserInfoPopup'
@@ -1075,8 +1076,10 @@ export const TaskList = forwardRef<TaskListRef, TaskListProps>(({ tasks: initial
               <PatientDetailView
                 patientId={selectedPatientId}
                 onClose={() => setSelectedPatientId(null)}
-                onSuccess={() => {
-                  onRefetch?.()
+                onSuccess={(hint?: PatientDetailListSuccessHint) => {
+                  if (hint?.needsPatientListRefetch ?? true) {
+                    onRefetch?.()
+                  }
                 }}
               />
             )}