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Identifying incidents of suboptimal care during paediatric emergencies-an observational study utilising in situ and
Fenton O'Leary1, Kathryn McGarvey2, Andrea Christoff3
1Emergency Department, The Children's Hospital at Westmead, Sydney, Australia; Disciplines of Emergency Medicine and Paediatrics and Child Health, Sydney Medical School, University Of Sydney, Australia.
Insights
Suboptimal care in paediatric emergencies was identified through simulations, with communication failures and knowledge gaps being key issues. Training programs need adaptation to address these factors for better patient outcomes.
Area of Science:
- Medical Education
- Emergency Medicine
- Paediatric Critical Care
Background:
- Life-threatening paediatric emergencies require rapid recognition and treatment by healthcare staff.
- Standardized simulations are crucial for evaluating and improving clinical performance in rare but critical events.
Purpose of the Study:
- To identify instances of suboptimal care during simulated paediatric emergencies.
- To determine the underlying causation factors contributing to these care deficits.
Main Methods:
- Qualitative thematic analysis of standardized simulated paediatric emergency scenarios.
- Data collection through direct observation, immediate post-scenario feedback, and facilitated debriefings.
- Attribution of identified incidents to seven pre-defined causation categories.
Main Results:
- 194 incidents of suboptimal care observed across 73 simulations involving 516 healthcare professionals.
- 325 causation factors identified, with communication failures (84) and knowledge deficits (76) being most prevalent.
- Key clinical themes included paediatric life support, drug administration, airway management, and recognition of patient deterioration.
Conclusions:
- Standardized simulations reveal significant incidents of suboptimal care in paediatric emergencies.
- Multiple causation factors, particularly communication and knowledge gaps, necessitate adaptation of current training programs.
- Improving training based on simulation findings can enhance the preparedness of staff for critical paediatric events.
Aim:
Life threatening paediatric emergencies are relatively uncommon events. When they do occur staff caring for these children must have the ability to recognise the deterioration, evaluate and simultaneously treat these patients. The aim of this study was to identify suboptimal care during standardised simulated scenarios and to identify the potential causation factors.
Methods:
Participants were emergency department and operating theatre staff in Sydney, Australia. Incidents of suboptimal care were identified during scenarios and were analysed by thematic qualitative assessment methods. Potential causation factors were elicited both during and immediately after the scenarios and during facilitated debriefings. Causation factors were attributed to any of seven pre-defined categories.
Results:
Seventy-three simulations occurred over 9 month period in 2011. 270 doctors, 235 nurses and 11 students participated. 194 incidents of suboptimal care were observed and attributed to 325 causation factors. There were 76 knowledge deficits, 39 clinical skill deficits, 36 leadership problems, 84 communication failures, 20 poor resource utilisations, 23 preparation and planning failures and 47 incidents of a loss of situational awareness. Clinically important themes were: paediatric life support, drug choice and doses, advanced airway and ventilation, intravenous fluids and recognition of the deteriorating patient. Recurring incidents included the failure to recognise a cardiac arrest, inadequate fluid resuscitation and incorrect medication dose administration.
Conclusions:
During standardised paediatric simulations multiple incidents of suboptimal care have been identified and multiple causation factors attributed to these. Educators should use this information to adapt current training programs to encompass these factors.
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