Board 280 - Program Innovations Abstract Interprofessional Education for Pediatric Resuscitation in the PACU using High-Fidelity Simulation in a Tertiary Care Pediatric Hospital (Submission #63)
Bibliographic record
Abstract
Introduction/Background Life-threatening pediatric emergencies in the post-anesthesia care unit (PACU) are infrequent but challenging for the staff, even in a tertiary care pediatric hospital. These high stakes situations require both medical knowledge and effective team crisis resource management (CRM): leadership, situation awareness, communication, team-work, planning, resource management and decision making. Simulation-based team training has been shown to be effective in improving these cognitive and non-technical skills In our institution, we introduced a monthly one hour training course using high-fidelity simulation-based training in order to optimize teamwork and efficiency in pediatric resuscitation in the PACU. This training was designed for staff pediatric anesthesiologists, PACU nurses and operating room respiratory therapists working in a tertiary care pediatric hospital. Methods Prior to each session, participants were given didactic material including PALS algorithms 2 and recommendations for team work in the context of CRM.3 Each training session consisted of two high-fidelity simulation scenarios based on real life events. The break down was two 10 minute high-fidelity simulations using Sim Baby(Laerdal) followed by a 20 minute interprofessional debriefing session. The first scenario focused on pulseless electrical activity secondary to severe hypoglycemia in a three month old, 3.5 kg ex-premie. The second scenario focused on ventricular arrythmias in the context of local anesthetic toxicity in a 14 month old child, post neuroblastoma resection with a thoracic epidural. The emphasis during debriefing was placed on : 1) Medical skills: PALS algorithm in the PACU context; 2) CRM principles : situational awareness, communication, decision making, task management and team work during a life threatening event in the PACU. Participants for each session included two staff anesthesiologists, two PACU nurses and two OR respiratory therapists. An evaluation survey was completed by the participants at the end of each session. Results: Conclusion After a 12 month period, 16 anesthesiologists (80%), 14 PACU nurses (100%) and 17 respiratory therapists (80%) participated in the course. Results from the post-course questionnaire : 1) Despite the wide range of clinical experience (less than 5 years to over 35 years), all the participants (anesthesiologists, nurses and respiratory therapists) really enjoyed the session, especially the opportunity to work together on rare but life threatening situations. Participants from all three professions reported that they most benefited from the CRM principles taught in the course, although the PALS review was also cited as being an important aspect. After the session most participants stated that they felt more confident in dealing with similar types of situations. This interprofessional training course was aimed at teams who are used to working together. It allowed participants to discuss both challenges surrounding communication and team work, in addition to the medical complexities. The principles evoked during this type of simulation-based training may be valuable in real life emergency situations. As this course was well received by the participants of all three professions, the future directions for this course include expanding to all the professionals involved in perioperative care and introducing objective measures of team performance. References 1. Fehr JJ, Honkanen A, Murray DJ : Simulation in pediatric anesthesiology. Pediatric Anesthesia 2012 ; 22 :988-94. 2. Kleinman ME, Chameides L, Schexnayder SM, Samson RA, Hazinski MF, Atkins DL et. Al. : Pediatric Advanced Life Support:: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010 ; 122 : S876-S908. 3. American heart Association : Effective Resuscitation Team Dynamics, Pediatric Advanced Life Support Provider Manual, First American Heart Association printing, 2011, pp 31-5. Disclosures None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.116 | 0.016 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".