Acute Multidisciplinary Pediatric Trauma Resuscitation Minna Wieck - - PowerPoint PPT Presentation

Initial Impact of Simulation-Based Training on Perceived Provider Confidence in Acute Multidisciplinary Pediatric Trauma Resuscitation

Minna Wieck MD, Alyssa Rake MD, Rita Burke PhD MPH, Heather Roesly, Caulette Young RN BSN CCRN, Todd Chang MD MAcM, Elizabeth Cleek RN MS CPNP , Inge Morton RN BSN CPN, Catherine Goodhue MN RN CPNP , Jeffrey Upperman MD, Aaron Jensen MD MEd

Requires Coordination

Level I Pediatric Trauma Centers Provide Crucial Team-Based Resuscitation

Barrier 1:

Low Volume of High Acuity Trauma

CHLA 2014 Level I Trauma Activations

Maegle M. World J Emerg Med 2010; 1: 12-21 Baker SP et al. J Trauma 14:187-196;1974

Mortality by ISS

190 potential providers

ED Attending: 17 Ed Fellow: 9 Surgical Resident: 13 Surgical Attending/Fellow: 14 ED Nurse: 90 PICU RN: 12 RCP: 12 ED Tech: 10 PharmD: 6 Radiology Tech: 10

Barrier 2:

Large Trauma Provider Pool

190 potential providers

Simulation-based training can improve performance

• Communication
• Task completion and

efficiency

• Patient safety
• Team performance
• Surgeon confidence

Capella J et al. J Surg Educ. 2010 Steinemann S et al. J Surg Educ. 2011 Knudson MM et al. J Trauma. 2008 Holcomb JB et al. J Trauma. 2002 Knudson MM et al. J Trauma 2008 Falcone Jr. RA et al. J Ped Surg. 2008 Patterson MD et al. BMJ Qual Safety. 2013 Pascual JL et al. J Trauma 2008

Confidence of all team members?

Purpose

Assess the impact of simulation-based training on provider confidence in team-based resuscitation of severely injured pediatric trauma patients

Methods: 4 in situ simulations

Scenarios

High fidelity patient simulators

Hypothesis

Implementation of high-fidelity simulation-based training and structured debriefing would improve perceptions of multidisciplinary trauma providers in three domains:

• 1. Provider Confidence
• 2. Provider Anxiety
• 3. Perceived Quality of Patient Care

Methods

Pre-training Survey Response rate: 93/190 (49%) 4 Simulations Participation rate: 56/190 (29%) Post –training Survey Response rate: 42/190 (22%)

• 15 trained
• 24 untrained

Provider Role by Survey Period

Provider Role Pre-Training N (%), total=93 Post-training N (%), total=42 PEM Physician 13 (14%) 11 (26%) Surgeon 15 (16%) 7 (17%) Registered Nurse 48 (51%) 18 (43%) Respiratory Care 12 (13%) Pharmacist Radiology Tech 3 (3%) Unknown 2 (2%) 6 (14%) p-value <0.05

Results

Pre-training: team performance needs improvement

Increased Anxiety In Trained Providers

Decreased Confidence In Trained Providers

Perceived Quality of Care

Identification and Communication of Patient Needs

• Simulation based training initially:

– Decreased provider confidence – Increased provider anxiety – Decreased perceived quality of patient care

• Possible explanations:

– Wake up call – Identified latent threats to safety

• Low response rate
• Difference in provider demographic
• Inability to link pre- and post- surveys

Limitations

• Simulation-based training serves as a needs

assessment for individual providers within a team

• In situ simulations can help identify latent safety

threats

• Further simulation-based training may lead to a

potential durable improvement in provider confidence and anxiety, teamwork, and patient

• utcomes
• Future studies need to evaluate barriers to

implementation of simulation based training

Conclusions

Acknowledgements

• Barbara M. Korsch Award for

Research in Medical Education