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Quality improvement utilizing in-situ simulation for a dual-hospital pediatric code response team
Phoebe Yager1, Corey Collins2, Carlene Blais2
1MassGeneral Hospital for Children, 175 Cambridge Street, CPZS-5, Boston, MA 02114, USA.
International Journal of Pediatric Otorhinolaryngology
|August 7, 2016
Summary
In-situ simulation effectively identified pediatric emergency response system inefficiencies. This program improved response times and intervention delivery before institutional implementation.
Area of Science:
- Medical Education
- Healthcare Systems Engineering
- Pediatric Emergency Medicine
Background:
- Pediatric emergency events are rare, making it challenging to identify system inefficiencies.
- In-situ simulation offers a method to uncover latent system-based challenges in emergency response.
Purpose of the Study:
- To develop and evaluate an in-situ, simulation-based program to identify and address inefficiencies in a dual-hospital pediatric code response system.
- To test quality improvement interventions in a safe, simulated environment prior to institutional rollout.
Main Methods:
- Utilized the Institute for Healthcare Improvement's (IHI) Breakthrough Model for Collaborative Improvement.
- Implemented Plan-Do-Study-Act cycles within a simulated, in-situ pediatric emergency setting across two hospitals.
- Focused on identifying workflow correlations, iterative intervention testing, and pre-implementation performance measurement.
Main Results:
- Simulated events revealed critical inefficiencies: delayed provider response, cardiopulmonary resuscitation (CPR) initiation, and vascular access.
- Identified root causes included unreliable pager activation, slow elevator response, and unfamiliarity with equipment.
- Post-intervention simulations showed significant reductions in response times, CPR initiation, and vascular access attainment.
Conclusions:
- The simulation-based program successfully identified system gaps in a complex pediatric code response.
- The IHI Breakthrough Model facilitated a safe environment for testing and refining quality improvement interventions.
- This approach enables effective pre-implementation assessment and enhancement of pediatric emergency response systems.
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