Abstract P38: Just-In-Time Simulation Training Improves ICU Physician Trainee Airway Resuscitation Participation without Compromising Procedural Success or Safety

Abstract

Introduction : Competence in orotracheal intubation is a requirement for Pediatric residency. However, opportunities for residents are limited. We hypothesize Just-in-Time simulation-based multi-disciplinary team training for acute airway resuscitation in a pediatric ICU (PICU) would improve physician trainee intubation participation and success, and decrease undesired T racheal I ntubation A ssociated E vents ( TIAE ) such as esophageal intubation, or mainstem intubation. Methods : With IRB approval, on-call residents in a tertiary PICU received 30 minute airway resuscitation multidisciplinary simulation training before 24 hour on-call duties. Airway resuscitation performance was captured in both simulated and real airway resuscitations using a validated airway registry (NEAR-4-KIDS) tool. Resident participation, success, first attempt success, and the incidence of TIAE were compared before and after this intervention (Pre: Jan 2005–Jun11, 2007; Post: Jun12, 2007–May2008). Analysis by time series analysis, and Fisher’s exact test. Results : 150 simulation training sessions were conducted, and 123 consecutive real orotracheal intubations were evaluated. Resident participation significantly increased: Pre 23 % vs Post 36 % (p=0.016). Overall resident airway resuscitation success (58% vs. 68%, p=0.39) and first attempt success (44% vs. 56%, p= 0.30) improvement were not statistically significant. Despite the increased participation by resident trainees, there was no increase in TIAE (23% vs. 21%, p=0.78) in real airway resuscitation. Conclusion : Simulation-based “Just-in-Time” multidisciplinary training for pediatric advanced airway resuscitation improved actual resident trainee participation in real ICU intubations, but did not compromise airway resuscitation procedural success or patient safety. Supported by Agency for Healthcare Research and Quality (AHRQ), and CHOP Endowed Chair, Critical Care Medicine