Abstract 121: Identification of Barriers for Out-of-Hospital Management of Acute Respiratory Distress in the Pediatric Patient Using Simulation and a Training Concept for Improvement
Objectives: For children, prompt out-of-hospital management of respiratory distress may prevent further deterioration and even death. We identified barriers to quality care for pediatric respiratory distress using human simulation and developed a focused educational intervention to address those barriers.
Methods: This observational cohort included randomly selected paramedic subjects from a large EMS system participating in validated respiratory distress scenarios using an infant human patient simulator before (Phase 1, October 2008) and after (Phase 2, June 2009) an educational intervention. The intervention was developed from barriers identified during Phase 1 and offered to all system paramedics in April 2009 through the online learning management system. Subjects were blinded to details of the scenario, including patient age and chief complaint. Clinical end-points such as vital signs were collected from the simulator logs. Expert evaluators reviewed simulator logs and videos and scored subjects on a patient management inventory for dichotomous (yes/no) measures of performance, timing, and success of various assessment and intervention items. Subjective ratings were made on a five-point Likert scale for overall assessment, airway control, oxygen administration and team work and analyzed using cumulative logistic regression. All other analyses were descriptive using univariate methods.
Results: Fifty-nine Phase 1 and 26 Phase 2 subjects had complete simulation video/logs and were analyzed. There were notable differences in patient management indices: 40 (68%) of Phase 1 subjects committed major protocol deviations (primarily incorrect protocol pathway) vs. 13 (50%) for Phase 2; 25 (42%) subjects initiated an IV during Phase 1 with 8 (32%) doing so prior to managing the airway vs. no Phase 2 subjects used IV. All Likert scale ratings for Phase 2 were significantly higher. No significant differences were identified for clinical endpoints.
Conclusions: High fidelity human simulation was useful in identifying issues with patient management that could likely lead to poor outcomes. Focused training proved to reduce deficiencies and resulted in more streamlined care that adhered more closely to system protocols and best practices.
- © 2010 by American Heart Association, Inc.