JOHNS HOPKINS: PEDIATRIC SIMULATION TRAINING FOR COMMUNITY ERS

At three hospitals in Maryland, training was provided using a high fidelity mannequin with content expertise. All three of the hospitals have dedicated small pediatric emergency rooms but are staffed only with general pediatricians and not with anyone with pediatric emergency medicine training or expertise. Two babies’ lives were saved this year as a direct result of our simulations! Babies presented to two separate emergency rooms had their illness recognized and appropriately treated due to the physician having previously participated in a simulation of the scenario.

Participating staff were surveyed at the end of the year at each site and found 99% of those surveyed reported increased comfort with pediatric patients from having participated in the scenarios, 94% hoped their departments would continue the simulation sessions in the future and 96% reported seeing positive changes in their emergency room’s preparedness for children as a result of participation in the project. Additionally, all 100% felt in situ simulation was a valuable teaching modality.

Simulation has been proven effective as a medical teaching tool in multiple studies. In this project simulation is delivered to a community emergency room setting in order to improve staff preparedness for pediatric patients and to uncover potential systems issues before they threaten a child.

A high fidelity mannequin was used and they were provided with content expertise. The team cared for the mannequin as if it were a real patient, utilizing the equipment and resources they have in their emergency room. Following each scenario an oral and a written debriefing were provided delineating both what went well and what the team/department needed to work on.

Changes have been seen in the equipment and resources availability based on issues that have arisen during these scenarios. These changes will positively impact the ability of the participating emergency room to care for infants and children. It was shown that staff are also performing far better at routine but complex tasks (like drawing up pediatric medications and providing airway support) than they were at the start of the project.

As a result of this training the following occurred:

A second site purchased new defibrillators that provide ongoing feedback during CPR to help ensure the best quality chest compressions.
Ongoing defibrillator training has taken place at all sites.
An ongoing abnormal heart rhythm recognition program has been adopted at all sites.
All sites now have expanded their pediatric, weight based, dosing manuals developed in prior program years and kept on their pediatric resuscitation carts and in their medication room.
One site has purchased additional Broselow tapes for their emergency department.
All sites are now utilizing a CPR coach during resuscitations to ensure the best quality CPR is delivered and ongoing CPR coaching training is taking place at all sites.
One site has purchased a pediatric glidescope and physician staff have undergone training in its use.
A formal written protocol for what to do after the death of a child in the emergency room has been created at one of the sites and includes medical and legal steps the staff must take as well as processes for ensuring that the family receives ongoing support.
The pharmacy has begun participating in all critical pediatric cases to facilitate medication dosing and administration.
The NICU and ER staff at one site have created a process to work smoothly together when a critically ill newborn presents to the ER.
One site is creating a list of medications and equipment available to them from the adult ER that are not stocked in the pediatric department.
One site had received extensive training on treating hypertension and hypertensive emergencies in the pediatric population.
Social work and pastoral care have had the opportunity to participate in the scenarios at all sites.