Balikai Shilpa C, Badheka Aditya, Casey Andrea, Endahl Eric, Erdahl Jennifer, Fayram Lindsay, Houston Amanda, Levett Paula, Seigel Howard, Vijayakumar Niranjan, Cifra Christina L
Division of Pediatric Critical Care, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa; and.
Pediatric Intensive Care Unit, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa.
Pediatr Qual Saf. 2020 Dec 28;6(1):e373. doi: 10.1097/pq9.0000000000000373. eCollection 2021 Jan-Feb.
To prevent transmission of severe acute respiratory syndrome coronavirus 2 to healthcare workers, we must quickly implement workflow modifications in the pediatric intensive care unit (PICU). Our objective was to rapidly train interdisciplinary PICU teams to safely perform endotracheal intubations in children with suspected or confirmed coronavirus disease 2019 using a structured simulation education program.
We conducted a quality improvement study in a tertiary referral PICU. After developing stakeholder-driven guidelines for modified intubation in this population, we implemented a structured simulation program to train PICU physicians, nurses, and respiratory therapists. We directly observed PICU teams' adherence to the modified intubation process before and after simulation sessions and compared participants' confidence using the Simulation Effectiveness Tool-Modified (SET-M, Likert scale range 0: do not agree to 2: strongly agree regarding statements of confidence).
Fifty unique PICU staff members participated in 9 simulation sessions. Observed intubation performance improved, with teams executing a mean of 7.3-8.4 out of 9 recommended practices between simulation attempts (.024). Before undergoing simulation, PICU staff indicated that overall they did not feel prepared to intubate patients with suspected or confirmed SARS-CoV-2 (mean SET-M score 0.9). After the simulation program, PICU staff confidence improved (mean SET-M score increased from 0.9 to 2, .001).
PICU teams' performance and confidence in safely executing a modified endotracheal intubation process for children with suspected or confirmed SARS-CoV-2 infection improved using a rapidly deployed structured simulation education program.
为防止严重急性呼吸综合征冠状病毒2传播给医护人员，我们必须迅速在儿科重症监护病房（PICU）实施工作流程调整。我们的目标是通过结构化模拟教育项目，迅速培训PICU跨学科团队，以便安全地为疑似或确诊2019冠状病毒病的儿童进行气管插管。
我们在一家三级转诊PICU开展了一项质量改进研究。在制定了针对该人群改良插管的利益相关者驱动指南后，我们实施了一个结构化模拟项目，以培训PICU医生、护士和呼吸治疗师。我们直接观察了PICU团队在模拟训练前后对改良插管过程的遵守情况，并使用改良模拟效果工具（SET-M，李克特量表范围0：不同意至2：非常同意关于信心陈述）比较了参与者的信心。
50名不同的PICU工作人员参加了9次模拟训练。观察到的插管表现有所改善，团队在模拟训练之间平均执行了9项推荐操作中的7.3 - 8.4项（P = 0.024）。在进行模拟训练之前，PICU工作人员表示总体上他们觉得没有准备好为疑似或确诊SARS-CoV-2的患者进行插管（平均SET-M评分为0.9）。模拟训练项目之后，PICU工作人员的信心有所提高（平均SET-M评分从0.9提高到2，P = 0.001）。
通过快速部署的结构化模拟教育项目，PICU团队在安全执行针对疑似或确诊SARS-CoV-2感染儿童的改良气管插管过程中的表现和信心得到了提高。
