Abstract P61: The Missing Link: Demonstration That Multidisciplinary Tracheal Intubation Simulation Training Improves Patient Safety and Team Behavior During Real Procedures in a Pediatric Intensive Care Unit
Tracheal intubation in a pediatric intensive care unit (PICU) is frequently performed in critically ill children with a high rate of unwanted associated events. Just-in-time (JIT) multidisciplinary simulation-based airway management team training was implemented to improve provider performance and team function. Our objective is to evaluate impact of simulation training on team behavior and actual patient outcome in clinical settings. We hypothesized that real observed team behavior and tracheal intubation associated events would be improved when more than one JIT simulation trained providers were present.
Methods: Research assistants were trained to use a validated task-based assessment tool (Just-in-Time Pediatric Advanced Airway Performance Scale: JIT-PAPPS) during simulation-based pediatric airway management. Actual PICU intubation performance by a team with more than 1 JIT simulation-trained members (JIT team) was compared to the team with 0 or 1JIT-trained members (non-JIT team). Intubation process of care and outcome were assessed independently by our prospective National Emergency Airway Registry for Kids (NEAR-4-KIDS) database. T-test, Fisher’s exact test and Pearson correlation as appropriate.
Results: Two research assistants (A1, A2) were trained with 53 simulation sessions: A1:16, A2: 37. Training effectiveness was confirmed by high correlation coefficient with expert facilitator ratings (A1: 0.73, p<0.0013, A2: 0.88, p<0.0001). A1 or A2 directly observed 18 real PICU intubations. JIT teams performed better compared to non-JIT teams (JIT-PAPPS: 127.2±2 vs. 116.4±4, p=0.012). Intubation success ≤2 attempts were JIT team 89% vs. non-JIT team 67% (p=0.53), unwanted tracheal intubation associated events in JIT team 0/9 vs. non-JIT team1/6 (p=0.40).
Conclusion: Provider and team behavior measured by JIT-PAPPS was better when more than one JIT simulation trained providers were present. Patient outcome and numbers of tracheal intubation association events were better, but did not reach statistical significance in this small pilot sample. This study fills in one missing link for process of care (e.g. competence on manikins translating to competence on patients), but relation to real patient outcomes requires further study.