Department of Anesthesiology and Critical Care Medicine, Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Pediatr Crit Care Med. 2011 Jul;12(4):406-14. doi: 10.1097/PCC.0b013e3181f52b2f.
Tracheal intubation in the pediatric intensive care unit is often performed in emergency situations with high risks. Simulation has been recognized as an effective methodology to train both technical and teamwork skills. Our objectives were to develop a feasible tool to evaluate team performance during tracheal intubation in the pediatric intensive care unit and to apply the tool in the clinical setting to determine whether multidisciplinary teams with a higher number of simulation-trained providers exhibit more proficient performance.
Prospective, observational pilot study.
Single tertiary children's hospital pediatric intensive care unit.
Pediatric and emergency medicine residents, pediatric intensive care unit nurses, and respiratory therapists from October 2007 to June 2008.
A pediatric intensive care unit on-call resident, a pediatric intensive care unit nurse, and a respiratory therapist received simulation-based multidisciplinary airway management training every morning. An assessment tool for team technical and behavioral skills was developed. Independent trained observers rated actual intubations in the pediatric intensive care unit by using this tool.
For observer training, two independent raters (research assistants 1 and 2) evaluated a total of 53 training sessions (research assistant 1, 16; research assistant 2, 37). The correlation coefficient with the facilitator expert (surrogate standard) was .73 for research assistant 1 and .88 for research assistant 2 (p ≤ .001 for both) in the total score, .84 for research assistant 1 and .77 for research assistant 2 (p < .001 for both) in the technical domain, and .63 for research assistant 1 (p = .009) and .84 for research assistant 2 (p < .001) in the behavioral domain. The correlation coefficient was lower in video-based observation (.62 vs. .88, on-site). For clinical observation, 15 intubations were observed in real time by raters. The performance by a team with two or more simulation-trained members was rated higher compared with the team with fewer than two trained members (total score: 127 ± 6 vs. 116 ± 9, p = .012, mean ± sd).
It is feasible to rate the technical and behavioral performance of multidisciplinary airway management teams during real intensive care unit intubation events by using our assessment tool. The presence of two or more multidisciplinary simulation-trained providers is associated with improved performance during real events.
儿科重症监护病房的气管插管通常在高风险的紧急情况下进行。模拟已被公认为一种训练技术和团队合作技能的有效方法。我们的目的是开发一种可行的工具来评估儿科重症监护病房气管插管过程中的团队绩效，并将该工具应用于临床环境，以确定具有更多模拟培训提供者的多学科团队是否表现出更熟练的性能。
前瞻性、观察性试点研究。
单所三级儿童医院儿科重症监护病房。
2007 年 10 月至 2008 年 6 月期间的儿科和急诊住院医师、儿科重症监护病房护士和呼吸治疗师。
一名儿科重症监护病房随叫随到的住院医师、一名儿科重症监护病房护士和一名呼吸治疗师每天早上接受基于模拟的多学科气道管理培训。开发了一种用于团队技术和行为技能评估的工具。独立的经过培训的观察员使用该工具对儿科重症监护病房的实际插管进行评估。
为了观察者培训，两名独立评估员（研究助理 1 和 2）共评估了 53 次培训课程（研究助理 1，16 次；研究助理 2，37 次）。研究助理 1 的相关系数与促进者专家（替代标准）为.73，研究助理 2 的相关系数为.88（p ≤.001 均），研究助理 1 的总分为.84，研究助理 2 的总分为.77（p <.001 均），研究助理 1 的技术域为.63（p =.009），研究助理 2 的行为域为.84（p <.001）。基于视频的观察结果较低（62 与 88，现场）。在临床观察中，15 次插管由评估员实时观察。由两个或更多经过模拟培训的成员组成的团队的表现评分高于由两个或更少经过培训的成员组成的团队（总分：127 ± 6 与 116 ± 9，p =.012，均值 ± 标准差）。
使用我们的评估工具，在实际重症监护病房插管事件中对多学科气道管理团队的技术和行为表现进行评分是可行的。存在两个或更多经过多学科模拟培训的提供者与实际事件中的表现提高相关。
