Improving Pediatric Diabetic Ketoacidosis Management in Community Emergency Departments Using a Simulation-Based...

Area of Science:

• Pediatric Emergency Medicine
• Medical Simulation
• Quality Improvement

Background:

• Community emergency departments (CEDs) often lack resources for pediatric diabetic ketoacidosis (DKA) care.
• This deficiency impacts the quality of care for acutely ill children.
• A simulation-based collaborative program was proposed to address these gaps.

Purpose of the Study:

• To evaluate the effectiveness of a simulation-based collaborative program.
• To improve the quality of care for pediatric DKA patients in CEDs.
• To measure adherence to DKA guidelines through simulated scenarios.

Main Methods:

• Prospective interventional study with 91 teams from 13 CEDs.
• In situ simulations in CED resuscitation bays, facilitated by an academic medical center (AMC) team.
• Adherence measured using a critical action checklist and analyzed with mixed linear regression.

Main Results:

• A 22-point improvement in overall adherence to the DKA checklist post-intervention.
• Six of nine critical checklist actions showed statistically significant improvement.
• Medium pediatric volume CEDs demonstrated the most improvement; those further from the AMC showed less.

Conclusions:

• In situ simulation-based collaborative programs significantly enhance adherence to pediatric DKA guidelines in CEDs.
• This approach offers a viable strategy for improving pediatric DKA management in resource-limited settings.
• The program demonstrated a positive impact on critical care actions for pediatric DKA.