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

Level I Pediatric Trauma Centers Provide Crucial Team-Based Resuscitation Requires Coordination

Barrier 1: Low Volume of High Acuity Trauma CHLA 2014 Level I Trauma Activations Mortality by ISS Maegle M. World J Emerg Med 2010; 1: 12-21 Baker SP et al. J Trauma 14:187-196;1974

Barrier 2: Large Trauma Provider Pool ED Attending: 17 Ed Fellow: 9 RCP: 12 Surgical Resident: 13 ED Nurse: 90 PICU RN: 12 ED Tech: 10 190 potential providers PharmD: 6 Radiology Tech: 10 Surgical Attending/Fellow: 14

190 potential providers

Simulation-based training can improve performance • Communication • Task completion and efficiency • Patient safety • Team performance • Surgeon confidence Confidence of all team members? Capella J et al. J Surg Educ. 2010 Knudson MM et al. J Trauma. 2008 Falcone Jr. RA et al. J Ped Surg. 2008 Steinemann S et al. J Surg Educ. 2011 Holcomb JB et al. J Trauma. 2002 Patterson MD et al. BMJ Qual Safety. 2013 Knudson MM et al. J Trauma 2008 Pascual JL et al. J Trauma 2008

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 4 Simulations Pre-training Survey Post – training Survey Participation rate: Response rate: Response rate: 56/190 (29%) 93/190 (49%) 42/190 (22%) • 15 trained • 24 untrained

Provider Role by Survey Period Provider Role Pre-Training Post-training N (%), total=93 N (%), total=42 PEM Physician 13 (14%) 11 (26%) Surgeon 15 (16%) 7 (17%) Registered Nurse 48 (51%) 18 (43%) Respiratory Care 12 (13%) 0 Pharmacist 0 0 Radiology Tech 3 (3%) 0 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

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

Conclusions • 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 outcomes • Future studies need to evaluate barriers to implementation of simulation based training

Acknowledgements • Barbara M. Korsch Award for Research in Medical Education