A comparison of rapid cycle deliberate practice and traditional reflective debriefing on interprofessional team performance.

Background: In simulation-based education, debriefing is necessary to promote knowledge acquisition and skill application. Rapid Cycle Deliberate Practice (RCDP) and Traditional Reflective Debriefing (TRD) are based in learning theories of deliberate practice and reflective learning, respectively. In this study, we compared the effectiveness of TRD versus RCDP on acquisition of conceptual knowledge and teamwork skills among interdisciplinary learners in the pediatric emergency department.

Let us to the TWISST; Plan, Simulate, Study and Act.

Unlabelled: Translational Work Integrating Simulation and Systems Testing (TWISST) is a novel application of simulation that augments how we discover, understand, and mitigate errors in our system. TWISST is a diagnostic and interventional tool that couples Simulation-based Clinical Systems Testing with simulation-based training (SbT). TWISST tests environments and work systems to identify latent safety threats (LSTs) and process inefficiencies.

Weight-Based Versus Flat Dosing of Epinephrine During Cardiac Arrest in the PICU: A Multicenter Survey.

Objectives: Pediatric Advanced Life Support (PALS) guidelines include weight-based epinephrine dosing recommendations of 0.01 mg/kg with a maximum of 1 mg, which corresponds to a weight of 100 kg. Actual practice patterns are unknown.

Simulation-based User-centered Design: An Approach to Device Development during COVID-19.

Introduction: Since the onset of COVID-19, intubations have become very high risk for clinical teams. Barrier devices during endotracheal intubation protect clinicians from the aerosols generated. Simulation-based user-centered design (UCD) was an iterative design process used to develop a pediatric intubation aerosol containment system (IACS).

Translational Simulation Improves Compliance with the NEAR4KIDS Airway Safety Bundle in a Single-center PICU.

Unlabelled: The National Emergency Airway Registry for Children (NEAR4KIDS) Airway Safety Quality Improvement (QI) Bundle is a QI tool to improve the safety of tracheal intubations. The ability to achieve targeted compliance with bundle adherence is a challenge for centers due to competing QI initiatives, lack of interdisciplinary involvement, and time barriers. We applied translational simulations to identify safety and performance gaps contributing to poor compliance and remediate barriers by delivering simulation-based interventions.

Mortality and Outcomes of Pediatric Tracheostomy Dependent Patients.

To describe clinical factors associated with mortality and causes of death in tracheostomy-dependent (TD) children. A retrospective study of patients with a new or established tracheostomy requiring hospitalization at a large tertiary children's hospital between 2009 and 2015 was conducted. Patient groups were developed based on indication for tracheostomy: pulmonary, anatomic/airway obstruction, and neurologic causes.

SAFEE: A Debriefing Tool to Identify Latent Conditions in Simulation-based Hospital Design Testing.

In the process of hospital planning and design, the ability to mitigate risk is imperative and practical as design decisions made early can lead to unintended downstream effects that may lead to patient harm. Simulation has been applied as a strategy to identify system gaps and safety threats with the goal to mitigate risk and improve patient outcomes. Early in the pre-construction phase of design development for a new free-standing children's hospital, Simulation-based Hospital Design Testing (SbHDT) was conducted in a full-scale mock-up.

Survey of Current Institutional Practices in the Use of High-Flow Nasal Cannula for Pediatric Patients.

Objectives: High-flow nasal cannula (HFNC) is an oxygen delivery device that provides heated humidified air with higher flow rates. The purpose of this survey is to look at institutional practice patterns of HFNC initiation, weaning, and disposition for pediatric patients across the United States.

Methods: Survey was sent via electronic listservs to pediatric physicians in emergency medicine, hospital medicine, critical care, and urgent care.

Can Simulation Based-Team Training Impact Bedside Teamwork in a Pediatric Intensive Care Unit?

Effective teamwork performance is essential to the delivery of high-quality and safe patient care. In this mixed methodological observational cohort study, we evaluated team performance immediately following a real medical crisis in a pediatric intensive care unit (PICU) following implementation of a simulation-based team training (SBTT) program. Comparison of teamwork skills when rated by study observers demonstrated a statistically significant improvement in 12 out of 15 composite teamwork skills during real emergency events following SBTT ( < 0.

Promoting Teamwork for Rapid Response Teams Through Simulation Training.

Use of teamwork skills during rapid response calls is important in the management of patient decompensation outside of the intensive care unit. The ability of a rapid response team (RRT) to influence patient outcomes depends on early team building and effective team performance. Simulation-based team training (SBTT) has been shown to be effective in teaching nontechnical teamwork skills.

Prevent Safety Threats in New Construction through Integration of Simulation and FMEA.

Introduction: The may impact safety and decisions made during the design phases can have unintended downstream effects that lead to patient harm. These flaws within the system are latent safety threats (LSTs). Simulation-based clinical systems testing (SbCST) provides a clinical context to examine the environment for safety threats postconstruction.

Simulation-based clinical systems testing for healthcare spaces: from intake through implementation.

Healthcare systems are urged to build facilities that support safe and efficient delivery of care. Literature demonstrates that the built environment impacts patient safety. Design decisions made early in the planning process may introduce flaws into the system, known as latent safety threats (LSTs).

Simulation-Based Palliative Care Communication for Pediatric Critical Care Fellows.

Background: Pediatric palliative care (PPC) education is lacking in pediatric critical care medicine (PCCM) fellowships, despite the desire of many program directors and fellows to expand difficult conversation training. Simulation-based training is an experiential method for practicing challenging communication skills such as breaking bad news, disclosing medical errors, navigating goals of care, and supporting medical decision-making.

Methods: We describe a simulation-based PPC communication series for PCCM fellows, including presimulation session, simulation session, debriefing, and evaluation methods.

Simulation-based education to improve emergency management skills in caregivers of tracheostomy patients.

Introduction: Children with tracheostomies are medically complex and may be discharged with limited and variably trained home nursing support. When faced with emergencies at home, caregivers must often take the lead role in management, and many lack experience with troubleshooting these emergencies prior to initial discharge.

Methods: A high-fidelity simulation-based tracheostomy education program was designed using a programmable mannequin (Gaumard HAL S3004 one-year-old pediatric simulator).

Rapid Cycle Deliberate Practice Versus Reflective Debriefing for Pediatric Septic Shock Training.

Objectives: Rapid cycle deliberate practice is a simulation training method that cycles between deliberate practice and directed feedback to create perfect practice; in contrast to reflective debriefing where learners are asked to reflect on their performance to create change. The aim of this study is to compare the impact of rapid cycle deliberate practice versus reflective debriefing training on resident application and retention of the pediatric sepsis algorithm.

Design: Prospective, randomized-control study.

A Survey Assessing Pediatric Transport Team Composition and Training.

Objective: The aim of this study was to assess national pediatric/neonatal specialty transport teams' composition and training requirements to determine if any current standardization exists.

Methods: This was a survey of the transport teams listed with the American Academy of Pediatrics via SurveyMonkey.

Results: While most of the teams maintain internal criteria for team competency and training, there is large variation across team compositions.

A Quality Initiative: A System-Wide Reduction in Serious Medication Events Through Targeted Simulation Training.

Introduction: Medication administration events (MAEs) are a great concern to the healthcare industry, because they are both common and costly. Pediatric patients pose unique challenges to healthcare systems, particularly regarding the safety of medication administration. Our objectives were to improve adherence to best practices, decrease MAEs, and decrease cost related to error reduction rates by implementing a scenario-based simulation training program for frontline nursing staff in the general care units, emergency departments, and intensive care units within our institution.

Use of plasma exchange in pediatric severe sepsis in children's hospitals.

Pediatric severe sepsis (PSS) is an important cause of death in children. Mortality increases in those with sepsis and multiple organ dysfunction syndrome (MODS). Plasma exchange (PE) has been used as an adjuvant therapy in sepsis, with trials demonstrating variable success.

Development and implementation of an early mobility program for mechanically ventilated pediatric patients.

Purpose: Early mobility (EM) is being used in adult ICUs in an effort to treat and prevent intensive care unit acquired weakness (ICU-AW) and Post-Intensive Care Syndrome (PICS). Data supports children suffer from ICU-AW and PICS as well. Our objective was to create and implement an EM protocol for pediatric patients receiving invasive mechanical ventilation.

Experience with the use of propofol for radiologic imaging in infants younger than 6 months of age.

Background: There is an increased risk associated with procedural sedation of infants younger than 6 months of age. The use of propofol for radiologic imaging of this age group is not well studied.

Objective: We hypothesize that adverse events are higher in the infant population receiving propofol for radiologic imaging.

A Novel Weaning Protocol for High-Flow Nasal Cannula in the PICU.

Objective: High-flow nasal cannula use in the PICU continues to increase; however, a protocol for weaning patients has yet to be published. This study aimed to create an efficient and safe protocol for weaning high-flow nasal cannula.

Design: A Respiratory Assessment Score was created using two validated scoring systems.

Resuscitation With Balanced Fluids Is Associated With Improved Survival in Pediatric Severe Sepsis.

Objective: To evaluate outcomes in patients receiving balanced fluids for resuscitation in pediatric severe sepsis.

Design: Observational cohort review of prospectively collected data from a large administrative database.

Setting: PICUs from 43 children's hospitals.