Simulation-Based Clinical Systems Testing Before Opening a Pediatric Critical Care Building.

Objective: We used simulation-based clinical systems testing (SbCST) to identify and mitigate latent safety threats (LSTs) before opening a large critical care building (CCB) at a pediatric institution.

Methods: We completed an SbCST project to identify LSTs before opening a 7-floor, 319-bed CCB at a pediatric institution. The extensive preparation process included warehouse planning sessions and a formal intake process.

CPR coach presence is associated with increased cardiopulmonary resuscitation guideline adherence in pediatric in-hospital cardiac arrest: a retrospective cohort study.

Background: High-quality cardiopulmonary resuscitation (CPR) improves patient outcomes but remains challenging to perform consistently. CPR coaches can support the team leader in ensuring high quality CPR. However, no studies have demonstrated improved pediatric patient outcomes with the use of a dedicated CPR coach during in-hospital cardiac arrest (IHCA).

Characteristics of Hot and Cold Debriefs for In-hospital Cardiac Arrest in the Pediatric Intensive Care Unit: A Mixed-methods Analysis.

Introduction: This study examined a standardized event review approach, assessing hot and cold debriefs in pediatric in-hospital cardiac arrest (IHCA) to demonstrate their distinct but synergistic values.

Methods: This retrospective mixed-methods analysis was conducted for 2 years in a large, single-center pediatric intensive care unit (PICU) at a quaternary care, free-standing children's hospital. Following the standardization of debriefing processes, both hot and cold debriefs were systematically performed after PICU IHCA events where chest compressions lasted longer than 1 minute, utilizing standardized debrief forms.

Caregivers' and Community Members' Perspectives on Firearm Safety Screening and Counseling During Pediatric Primary Care Visits.

To assess caregivers' and community members' perspectives on a potential communication framework for pediatricians to provide firearm safety counseling in primary care via focus groups. Participants recommended embedding the topic within injury prevention counseling, sharing information on safe storage, and screening for storage strategies rather than gun ownership.

A Needs Assessment of Labor and Delivery Nurses Performing NRP in the Delivery Room.

Introduction: Labor and delivery (L&D) nurses are often responsible for initiating the critical first steps of the Neonatal Resuscitation Program (NRP). Identification of knowledge gaps and underlying reasons for NRP non-adherence is crucial for designing educational interventions.

Methods: A convenience sample of 37 L&D nurses from two delivery hospitals were enrolled.

Feasibility and Acceptability of a Virtual Reality Curriculum to Support Firearm Safety Counseling Skills Among Pediatric Residents.

Firearm-related injury is the leading cause of death among US children and adolescents. Residents across specialties report low preparedness to provide firearm safety counseling. Virtual reality (VR) may offer a modality to support residents' skills through deliberate practice in a simulated setting.

A Randomized Trial of Virtual Reality Training to Improve Firearm Safety Counseling Skills.

Objective: To evaluate the efficacy of Resident Education And Counseling on Household (REACH) Firearm Safety, a novel virtual reality (VR) intervention.

Methods: We conducted a single-center, randomized controlled trial among pediatric residents in a Midwestern academic primary care center comparing REACH Firearm Safety with didactic training (intervention) to didactic training alone (control). In the intervention arm, participants practiced firearm safety counseling with virtual characters and received immediate feedback.

Paediatric resident identification of cardiac emergencies.

Objectives: Critical CHD is associated with morbidity and mortality, worsened by delayed diagnosis. Paediatric residents are front-line clinicians, yet identification of congenital CHD remains challenging. Current exposure to cardiology is limited in paediatric resident education.

Impact of a relocation to a new critical care building on pediatric safety events.

Background: Cincinnati Children's Hospital Medical Center (CCHMC) relocated the pediatric, cardiac, and neonatal intensive care units (PICU, CICU and NICU) to a newly constructed critical care building (CCB) in November 2021. Simulation and onboarding sessions were implemented before the relocation, aimed at mitigating latent safety threats.

Objective: To evaluate the impact of ICU relocation to the CCHMC CCB on patient safety as measured by the quantity, rate, severity score, and category of safety reports.

Impact of Virtual Reality Simulation on New Nurses' Assessment of Pediatric Respiratory Distress.

Background: Children often experience respiratory illnesses requiring bedside nurses skilled in recognizing respiratory decompensation. Historically, recognizing respiratory distress has relied on teaching during direct patient care. Virtual reality simulation may accelerate such recognition among novice nurses.

Usability Testing of Situation Awareness Clinical Decision Support in the Intensive Care Unit.

Objective:  Our objective was to evaluate the usability of an automated clinical decision support (CDS) tool previously implemented in the pediatric intensive care unit (PICU) to promote shared situation awareness among the medical team to prevent serious safety events within children's hospitals.

Methods:  We conducted a mixed-methods usability evaluation of a CDS tool in a PICU at a large, urban, quaternary, free-standing children's hospital in the Midwest. Quantitative assessment was done using the system usability scale (SUS), while qualitative assessment involved think-aloud usability testing.

Multiuser immersive virtual reality simulation for interprofessional sepsis recognition and management.

Introduction: Sepsis is a leading cause of pediatric mortality. While there has been significant effort toward improving adherence to evidence-based care, gaps remain. Immersive multiuser virtual reality (MUVR) simulation may be an approach to enhance provider clinical competency and situation awareness for sepsis.

Experience informed procedural skills training.

Background: Paediatric critical care (PCC) physicians must perform several emergent procedures independently and competently-requiring transition from novice to competent over a 3-year fellowship. However, skill acquisition is not uniform. Individualised training, adapted to the unique experiences and requirements of each trainee, may enhance competency.

Tolerability and Acceptability of Autonomous Immersive Virtual Reality Incorporating Digital Twin Technology for Mass Training in Healthcare.

Introduction: As part of onboarding and systems testing for a clinical expansion, immersive virtual reality (VR) incorporating digital twin technology was used. While digital twin technology has been leveraged by industry, its use in health care has been limited with no prior application for onboarding or training. The tolerability and acceptability of immersive VR for use by a large population of healthcare staff were unknown.

Use of design thinking and human factors approach to improve situation awareness in the pediatric intensive care unit.

Background: Optimal design of healthcare spaces can enhance patient care. We applied design thinking and human factors principles to optimize communication and signage on high risk patients to improve situation awareness in a new clinical space for the pediatric ICU.

Objective: To assess the impact of these tools in mitigating situation awareness concerns within the new clinical space.

Just-in-Time, Just-in-Place Virtual Training in the Pediatric Emergency Department: A Novel Approach to Impact the Perfusion Exam.

Background: Early identification of shock is vital in decreasing morbidity and mortality in the pediatric population. Although residents are taught the perfusion portion of the rapid cardiopulmonary assessment at our institution, they perform it at the bedside with 8.4% completing 1 part of the assessment and 9.

How Augmenting Reality Changes the Reality of Simulation: Ethnographic Analysis.

Background: Simulation-based medical education (SBME) provides key medical training for providers to safely and ethically practice high-risk events. Augmented reality (AR)-enhanced simulation projects digital images of realistic examination findings into a participant's field of view, which allows nuanced physical examination findings such as respiratory distress and skin perfusion to be prominently displayed. It is unknown how AR compares to traditional mannequin (TM)-based simulation with regard to influencing participant attention and behavior.

Virtual Reality to Assess Resident Recognition of Impending Respiratory Failure During COVID-19.

Objectives: To assess the performance of pediatric residents in recognizing a decompensating patient with impending respiratory failure and appropriately escalating care using a virtual reality (VR) simulated case of an infant with bronchiolitis after an extended period of decreased clinical volumes during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: Sixty-two pediatric residents at a single academic pediatric referral center engaged in a 30-minute VR simulation on respiratory failure in a 3-month-old admitted to the pediatric hospital medicine service with bronchiolitis. This occurred in a socially distant manner across the Zoom platform during the COVID-19 pandemic (January-April 2021).

Using Technology to Overcome Vaccine Hesitancy.

Technology holds great potential to address many vaccine hesitancy determinants and support vaccine uptake given its ability to amplify positive messages, support knowledge, and enhance providers' recommendations. Modalities previously implemented with variable success have included automated reminder systems, decision support for clinicians, online education programs, social media campaigns, and virtual reality curricula. Further research is needed to identify the optimal uses of technology at the patient/parent and provider levels to overcome vaccine hesitancy.

Implementation and Evaluation of an Artificial Intelligence Driven Simulation to Improve Resident Communication With Primary Care Providers.

Our artificial intelligence platform facilitated, evaluated, and provided real-time feedback on a standardized, simulated conversation. Learners evaluated the experience as equally effective to traditional education modalities and reported that it reinforced key communication elements, which would impact their future communication.

Remote Virtual Reality Teaching: Closing an Educational Gap During a Global Pandemic.

Objective: Resident physicians are expected to recognize patients requiring escalation of care on day 1 of residency, as outlined by the Association of American Medical Colleges. Opportunities for medical students to assess patients at the bedside or through traditional simulation-based medical education have decreased because of coronavirus disease 2019 restrictions. Virtual reality (VR) delivered remotely via video teleconferencing may address this educational gap.