From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indiana University Health, Indianapolis, IN.
LifeLine Critical Care Transport.
Pediatr Emerg Care. 2021 Nov 1;37(11):543-549. doi: 10.1097/PEC.0000000000001751.
The majority of pediatric patients with diabetic ketoacidosis (DKA) present to community emergency departments (CEDs) that are less prepared to care for acutely ill children owing to low pediatric volume and limited pediatric resources and guidelines. This has impacted the quality of care provided to pediatric patients in CEDs. We hypothesized that a simulation-based collaborative program would improve the quality of the care provided to simulated pediatric DKA patients presenting to CEDs.
This prospective interventional study measured adherence of multiprofessional teams caring for pediatric DKA patients preimplementation and postimplementation of an improvement program in simulated setting. The program consisted of (a) a postsimulation debriefing, (b) assessment reports, (c) distribution of educational materials and access to pediatric resources, and (d) ongoing communication with the academic medical center (AMC). All simulations were conducted in situ (in the CED resuscitation bay) and were facilitated by a collaborative team from the AMC. A composite adherence score was calculated using a critical action checklist. A mixed linear regression model was performed to examine the impact of CED and team-level variables on the scores.
A total of 91 teams from 13 CEDs participated in simulated sessions. There was a 22-point improvement of overall adherence to the DKA checklist from the preintervention to the postintervention simulations. Six of 9 critical checklist actions showed statistically significant improvement. Community emergency departments with medium pediatric volume showed the most overall improvement. Teams from CEDs that are further from the AMC showed the least improvement from baseline.
This study demonstrated a significant improvement in adherence to pediatric DKA guidelines in CEDs across the state after execution of an in situ simulation-based collaborative improvement program.
大多数患有糖尿病酮症酸中毒（DKA）的儿科患者会前往社区急诊部（CED）就诊，由于儿科就诊量低、儿科资源和指南有限，这些部门对急性病患儿的护理能力较差。这影响了 CED 为儿科患者提供的护理质量。我们假设基于模拟的协作计划将提高 CED 为就诊的模拟儿科 DKA 患者提供的护理质量。
这项前瞻性干预研究在模拟环境中测量了多专业团队在实施和实施改善计划前后对儿科 DKA 患者的护理依从性。该计划包括（a）模拟后情况汇报，（b）评估报告，（c）教育材料的分发和儿科资源的获取，以及（d）与学术医疗中心（AMC）的持续沟通。所有模拟都是在原地（CED 复苏区）进行的，并由来自 AMC 的协作团队进行协助。使用关键行动清单计算综合依从性评分。使用混合线性回归模型检验 CED 和团队水平变量对评分的影响。
共有来自 13 个 CED 的 91 个团队参加了模拟会议。从干预前模拟到干预后模拟，对 DKA 检查表的整体依从性提高了 22 分。6 项关键检查表行动显示出统计学上的显著改善。儿科就诊量中等的 CED 总体改善最大。距离 AMC 较远的 CED 团队的基线改善最小。
这项研究表明，在执行基于现场模拟的协作改进计划后，全州范围内 CED 对儿科 DKA 指南的依从性显著提高。
