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Development of an instrument for a primary airway provider's performance with an ICU multidisciplinary team in
Akira Nishisaki1, Aaron J Donoghue, Shawn Colborn
1Children's Hospital of Philadelphia, Philadelphia, PA, USA. Nishisaki@email.chop.edu
Insights
A new scoring system, the Just-in-Time Pediatric Airway Provider Performance Scale (JIT-PAPPS), effectively assesses multidisciplinary pediatric intensive care unit (PICU) teams managing respiratory failure. This validated tool aids in evaluating pediatric airway management performance.
Area of Science:
- Pediatric critical care medicine
- Healthcare simulation
- Patient safety
Background:
- Effective management of pediatric respiratory failure in the ICU requires multidisciplinary team coordination.
- Assessing the performance of these teams, particularly during critical airway events, is challenging.
- Standardized tools are needed to evaluate the complex interplay of skills in pediatric intensive care units (PICUs).
Purpose of the Study:
- To develop and validate a scoring system for assessing multidisciplinary team management of pediatric respiratory failure.
- To evaluate the performance of pediatric ICU teams using a simulation-based approach.
- To enhance patient safety through improved assessment of airway management protocols.
Main Methods:
- A task-based scoring instrument, the Just-in-Time Pediatric Airway Provider Performance Scale (JIT-PAPPS), was developed using Healthcare Failure Mode and Effect Analysis.
- Pediatric and emergency medicine residents, nurses, and respiratory therapists participated in simulation-based evaluations.
- The instrument's reliability and validity were assessed using 3 independent expert raters and correlation with global assessments and prior training experience.
Main Results:
- The JIT-PAPPS version 3, comprising 34 task-based items (14 technical, 20 behavioral), was finalized.
- Eighty-five teams were evaluated, showing good inter-rater reliability (intraclass correlation coefficient = 0.64).
- JIT-PAPPS scores demonstrated strong correlation with global ratings (r = 0.71) and were positively associated with prior training, supporting its validity.
Conclusions:
- The JIT-PAPPS is a reliable and valid tool for assessing primary airway provider performance within a multidisciplinary pediatric ICU team during simulated respiratory failure.
- The scale supports objective evaluation of technical and behavioral skills in pediatric airway management.
- This scoring system can contribute to improving training and performance in pediatric critical care settings.
Objective:
To develop a scoring system that can assess the multidisciplinary management of respiratory failure in a pediatric ICU.
Methods:
In a single tertiary pediatric ICU we conducted a simulation-based evaluation in a patient care area auxiliary to the ICU. The subjects were pediatric and emergency medicine residents, nurses, and respiratory therapists who work in the pediatric ICU. A multidisciplinary focus group with experienced providers in pediatric ICU airway management and patient safety specialists was formed. A task-based scoring instrument was developed to evaluate a primary airway provider's performance through Healthcare Failure Mode and Effect Analysis. Reliability and validity of the instrument were evaluated using multidisciplinary simulation-based airway management training sessions. Each session was evaluated by 3 independent expert raters. A global assessment of the team performance and the previous experience in training were used to evaluate the validity of the instrument.
Results:
The Just-in-Time Pediatric Airway Provider Performance Scale (JIT-PAPPS) version 3, with 34 task-based items (14 technical, 20 behavioral), was developed. Eighty-five teams led by resident airway providers were evaluated by 3 raters. The intraclass correlation coefficient for raters was 0.64. The JIT-PAPPS score correlated well with the global rating scale (r = 0.71, P < .001). Mean total scores across the teams were positively associated with resident previous training participation (β coefficient 7.1 ± 0.9, P < .001), suggesting good validity of the scale.
Conclusions:
A task-based scoring instrument for a primary airway provider's performance with a multidisciplinary pediatric ICU team on simulated pediatric respiratory failure was developed. Reliability and validity evaluation supports the developed scale.
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