Development and pilot of an interprofessional pediatric resuscitation program for non-acute care inpatient providers

Ronish Gupta,Colleen Fitzgibbons,Christa Ramsay,Lindsey Vanderheiden,Christina Toppozini,Anna-Theresa Lobos

doi:10.1080/10872981.2019.1581521

Abstract

ABSTRACTMultiprofessional ward healthcare providers are generally unprepared to assemble and engage in the initial resuscitation of pediatric inpatients. This is important as the performance of these first-responders, in the several minutes prior to the arrival of acute care support, may have significant effects on overall patient outcome. Accordingly, we aimed to develop and pilot a training program intended for non-acute care inpatient providers, relevant to their working context. Using the latest theory and evidence in medical education, we created an interprofessional, entirely in-situ, simulation-based small-group activity. The activity was then piloted for four months with the goals of assessing perceived usefulness, as well as implementation factors such as participant accessibility and overall resource requirements. A total of 37 interprofessional (physician and nursing) staff were trained in 16 small group sessions over four months. Post-participation questionnaires revealed that the activity was perceived to be highly useful for their practice; especially the rapid cycle deliberate practice instructional method, and the increased focus on crisis resource management. Resource requirements were comparable to, and perhaps less than, existing acute care training programs. This project describes the preliminary steps taken in creating a curriculum intended to improve interprofessional resuscitation performance across an institution.

Highlights

Introduction and rationaleReview of location, assembly, and use of bag-valve mask suction equipmentDemonstration of algorithm by instructorsParticipant-led simulations 1 (3%) 6 (19%) 24 (77%)Program Areas of Use of in-situ location and equipment for Strength training ‘This was essential we often don’t know where the equipment is located’‘It’s extremely useful to have a situation in the room- situational awareness knowing how to use the equipment that is on the ward.’Opportunity to practice crisis management with interprofessional colleagues ‘Loved this! Help[ed] bring down some of the anxiety and allow[ed] us to practice taking a step back to gain control’‘This was great! Love that it is interdisciplinary’Process of rapid cycle deliberate practice training ‘Enjoyed starting and stopping scenario with suggestions for improvement’
Despite some improvements over time, a recent multi-center review of pediatric inpatient arrest events showed that rates of survival to hospital discharge were below 50% [1]
Code blue and medical emergency teams have been implemented to improve the delivery of acute care expertise to patients outside critical-care areas [2]

Summary

Introduction

Code blue and medical emergency teams have been implemented to improve the delivery of acute care expertise to patients outside critical-care areas [2] Studies in both adult and pediatric populations show that prior to the arrival of acute care teams, initial resuscitative efforts by ward first-responders are variable and often sub-standard [3,4,5], potentially impacting patient outcome. In California, medical educators recognized this gap and developed an interprofessional training program utilizing in-situ simulation scenarios and found improvements in participant selfconfidence ratings [7]. This experience provides some initial strategies and may be expanded upon by several recent advances in resuscitation education science and best practice suggestions [8]

Objectives

Methods

Results

Conclusion