Usability Testing Via Simulation: Optimizing the NEAR4PEM Preintubation Checklist With a Human Factors Approach.

Objectives: To inform development of a preintubation checklist for pediatric emergency departments via multicenter usability testing of a prototype checklist.

Methods: This was a prospective, mixed methods study across 7 sites in the National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM) collaborative. Pediatric emergency medicine attending physicians and senior fellows at each site were first oriented to a checklist prototype, including content previously identified using a modified Delphi approach.

De-escalation of the Agitated Pediatric Patient: A Standardized Patient Case for Pediatric Residents.

Introduction: Over the past 5 years, pediatric mental health emergencies requiring emergency safety evaluations and inpatient boarding of pediatric patients requiring psychiatric admission have increased. Pediatric trainees must learn to effectively and safely de-escalate a patient with agitated or aggressive behavior, as mental health patients take up a larger proportion of their patient population. This standardized patient case addresses gaps in knowledge and skills to ameliorate the care of children and adolescents with behavioral crises in the hospital.

Pediatric Polytrauma Fire Victim Simulation.

Introduction: Pediatric trauma has long been one of the primary contributors to pediatric mortality. There are multiple cases in the literature involving cyanide (CN) toxicity, carbon monoxide (CO) toxicity, and smoke inhalation with thermal injury, but none in combination with mechanical trauma.

Methods: In this 45-minute simulation case, emergency medicine residents and fellows were asked to manage a pediatric patient with multiple life-threatening traumatic and metabolic concerns after being extracted from a van accident with a resulting fire.

Fellowship Accreditation: Experiences From Health Care Simulation Experts.

The field of health care simulation continues to grow, accompanied by a proliferation of fellowship programs, leading to fellowship accreditation efforts. There is controversy around the best approach to accreditation. The authors sought to understand perspectives of simulation leaders on fellowship accreditation to best inform the growth and maturation of fellowship accreditation.

Implicit Bias and Patient Care: Mitigating Bias, Preventing Harm.

Introduction: Simulation is a valuable and novel tool in the expanding approach to racism and bias education for medical practitioners. We present a simulation case focused on identifying and addressing the implicit bias of a consultant to teach bias mitigation skills and limit harm to patients and families.

Methods: Learners were presented with a case of a classic toddler's fracture in an African American child.

Excellence in Communication and Emergency Leadership (ExCEL): Pediatric Critical Care Resource Utilization Workshop for Residents.

Introduction: Efficiently locating critical equipment and prompt defibrillator usage are crucial steps when managing a critically ill patient or a code. However, resident experience in this area is limited. This workshop focused on the identification of critical care equipment in the pediatric code cart and transport bag along with timely, appropriate, and effective use of the defibrillator when needed.

COVID-19 Pneumonia and Status Asthmaticus With Respiratory Failure in a Pediatric Patient: A Simulation for Emergency Medicine Providers.

Introduction: During COVID-19 surges, medical trainees may perform patient care outside typical clinical responsibilities. While respiratory failure in pediatric patients secondary to COVID-19 is rare, it is critical that providers can effectively care for these children while protecting the health care team. Simulation is an important tool for giving learners a safe environment in which to learn and practice these new skills.

Faculty support bundle for simulation education.

Background: Postgraduate training programmes rely on faculty to meet core educational needs, including simulation. Time is arguably the most valuable resource for academic physicians, which presents a challenge for recruiting faculty to provide extra-clinical teaching. To increase faculty engagement in simulation-based education (SBE), we first identified barriers to participation.

Accreditation of Simulation Fellowships and Training Programs: More Checkboxes or Elevating the Field?

As the field of healthcare simulation matures, formal accreditation for simulation fellowships and training programs has become increasingly available and touted as a solution to standardize the education of those specializing in healthcare simulation. Some simulation experts hold opposing views regarding the potential value of simulation fellowship program accreditation. We report on the proceedings of a spirited debate at the 20th International Meeting on Simulation in Healthcare in January 2020.

Excellence in Communication and Emergency Leadership (ExCEL): Pediatric Primary and Secondary Survey in Trauma Workshop for Residents.

Introduction: Unintentional traumatic injury remains the leading cause of pediatric death in the United States. There is wide variation in the assessment and management of pediatric trauma patients in emergency departments. Resident education on trauma evaluation and management is lacking.

Pediatric Airway Assessment Tool (PAAT): A Rating Tool to Assess Resident Proficiency in Simulated Pediatric Airway Skills Performance.

Introduction: The Accreditation Council for Graduate Medical Education has identified the need for assessment of core skills for pediatric and emergency medicine residents, which includes pediatric airway management. Although there are standard courses for pediatric airway management, there is no validated tool to assess basic and advanced pediatric airway skills performance. Our objective was to develop a simulation-based tool for the formative assessment of resident pediatric airway skills performance that was concise, yet comprehensive, and to evaluate the evidence supporting the argument for the tool's validity.

Excellence in Communication and Emergency Leadership (ExCEL): Pediatric First 5 Minutes Workshop for Residents.

Introduction: In-hospital pediatric cardiopulmonary arrest is associated with high morbidity and mortality, and appropriate initial management has been associated with improved clinical outcomes. Despite current training, pediatric residents often do not feel confident in their ability to deliver this initial management. This workshop focused on the initial management of critically ill pediatric patients and performance of high-quality CPR.

Thyrotoxicosis in a Postpartum Adolescent: A Simulation Case for Emergency Medicine Providers.

Introduction: Thyroid storm is a rare but life-threatening disease process that may be difficult to recognize and mimics other disease processes. It is critical for the emergency medicine clinician to be able to recognize thyroid storm in patients in order to effectively stabilize and treat them.

Methods: In this standardized patient case, learners were faced with a 17-year-old postpartum woman presenting to the emergency department with respiratory distress and altered mental status secondary to thyroid storm.

Simulation-Based Examination of Arterial Line Insertion Method Reveals Interdisciplinary Practice Differences.

Introduction: Arterial cannulation is frequently performed on intensive care unit (ICU) and operating room patients; a 1% complication rate has been reported. Investigators applied simulation to study clinical providers' arterial catheter (AC) insertion performance and to assess for interdisciplinary and intradisciplinary variation that may contribute to complications.

Methods: Anesthesia, medical critical care, and surgical critical care providers with AC insertion experience were enrolled at 2 academic hospitals.

Pediatric Out-of-Hospital Cardiac Arrest in Rhode Island: Concepts and Controversies.

Pediatric out-of-hospital cardiac arrest (POHCA) is an infrequently encountered event by emergency medical providers, both across Rhode Island and nationally. The etiologies of these events differ from those in adult cardiac arrests and overall outcomes remain poor. The skills required by emergency medical providers to care for these patients are performed and practiced infrequently.

Comparison of EMS Provider In-Transit Performance and Exertion with Standard and Experimental Resuscitation Protocols during Simulated Out-of-Hospital Cardiac Arrest.

Objective: To assess the effect of a device-assisted out- of-hospital cardiac arrest (OHCA) resuscitation approach on provider performance during simulated transport.

Methods: BLS and ALS providers were randomized into control and experimental teams. Subjects were fitted with wireless heart rate (HR) monitors.

Comparative Analysis of Emergency Medical Service Provider Workload During Simulated Out-of-Hospital Cardiac Arrest Resuscitation Using Standard Versus Experimental Protocols and Equipment.

Introduction: Protocolized automation of critical, labor-intensive tasks for out-of-hospital cardiac arrest (OHCA) resuscitation may decrease Emergency Medical Services (EMS) provider workload. A simulation-based assessment method incorporating objective and self-reported metrics was developed and used to quantify workloads associated with standard and experimental approaches to OHCA resuscitation.

Methods: Emergency Medical Services-Basic (EMT-B) and advanced life support (ALS) providers were randomized into two-provider mixed-level teams and fitted with heart rate (HR) monitors for continuous HR and energy expenditure (EE) monitoring.

Team Size and Stretching-Exercise Effects on Simulated Chest Compression Performance and Exertion.

Introduction: Investigators conducted a prospective experimental study to evaluate the effect of team size and recovery exercises on individual providers' compression quality and exertion. Investigators hypothesized that 1) larger teams would perform higher quality compressions with less exertion per provider when compared to smaller teams; and 2) brief stretching and breathing exercises during rest periods would sustain compressor performance and mitigate fatigue.

Methods: In Phase I, a volunteer cohort of pre-clinical medical students performed four minutes of continuous compressions on a Resusci-Anne manikin to gauge the spectrum of compressor performance in the subject population.

Patient Simulation for Assessment of Layperson Management of Opioid Overdose With Intranasal Naloxone in a Recently Released Prisoner Cohort.

Introduction: Investigators applied simulation to an experimental program that educated, trained, and assessed at-risk, volunteering prisoners on opioid overdose (OD) prevention, recognition, and layperson management with intranasal (IN) naloxone.

Methods: Consenting inmates were assessed for OD-related experience and knowledge then exposed on-site to standardized didactics and educational DVD (without simulation). Subjects were provided with IN naloxone kits at time of release and scheduled for postrelease assessment.

Interdisciplinary Development of an Improved Emergency Department Procedural Work Surface Through Iterative Design and Use Testing in Simulated and Clinical Environments.

Study Objective: A stable and readily accessible work surface for bedside medical procedures represents a valuable tool for acute care providers. In emergency department (ED) settings, the design and implementation of traditional Mayo stands and related surface devices often limit their availability, portability, and usability, which can lead to suboptimal clinical practice conditions that may affect the safe and effective performance of medical procedures and delivery of patient care. We designed and built a novel, open-source, portable, bedside procedural surface through an iterative development process with use testing in simulated and live clinical environments.

Development and Application of a Clinical Microsystem Simulation Methodology for Human Factors-Based Research of Alarm Fatigue.

Objectives: (1) To develop a clinical microsystem simulation methodology for alarm fatigue research with a human factors engineering (HFE) assessment framework and (2) to explore its application to the comparative examination of different approaches to patient monitoring and provider notification.

Background: Problems with the design, implementation, and real-world use of patient monitoring systems result in alarm fatigue. A multidisciplinary team is developing an open-source tool kit to promote bedside informatics research and mitigate alarm fatigue.

Simulation-based Randomized Comparative Assessment of Out-of-Hospital Cardiac Arrest Resuscitation Bundle Completion by Emergency Medical Service Teams Using Standard Life Support or an Experimental Automation-assisted Approach.

Introduction: Effective resuscitation of out-of-hospital cardiac arrest (OHCA) patients is challenging. Alternative resuscitative approaches using electromechanical adjuncts may improve provider performance. Investigators applied simulation to study the effect of an experimental automation-assisted, goal-directed OHCA management protocol on EMS providers' resuscitation performance relative to standard protocols and equipment.

Objective Assessment and Thematic Categorization of Patient-audible Information in an Emergency Department.

Objectives: The objective was to assess and categorize the understandable components of patient-audible information (e.g., provider conversations) in emergency department (ED) care areas and to initiate a baseline ED soundscape assessment.