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Improvement of Pediatric Advanced Airway Management in General Emergency Departments After a Collaborative
Manahil Mustafa1, Riad Lutfi2, Hani Alsaedi2
1Pediatrics, Hurley Medical Center and Michigan State University, Flint, Michigan.
Insights
A simulation program improved pediatric airway management in emergency departments, reducing critical events and improving patient outcomes. This shows simulation training can translate to better real-world pediatric care.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
- Medical Simulation
Background:
- Advanced airway management in critically ill pediatric patients presents challenges in general emergency departments due to limited resources and varying experience.
- Previous research indicates simulation training can enhance pediatric airway management skills in simulated environments.
- This study investigates the impact of an in situ simulation-based collaborative intervention on actual clinical practice in pediatric airway management.
Purpose of the Study:
- To evaluate the effectiveness of an in situ simulation-based collaborative intervention program.
- To assess the impact of the intervention on the quality of pediatric airway management in general emergency departments.
- To determine if improvements seen in simulation translate to improved clinical outcomes.
Main Methods:
- A retrospective study analyzed data from 135 critically ill pediatric patients requiring intubation across 9 general emergency departments.
- The primary outcome measured was the quality of clinical care, assessed using a critical action checklist for adherence to best practices.
- Secondary outcomes included tracheal intubation-associated adverse events and overall clinical outcomes.
Main Results:
- Post-intervention, the use of cuffed endotracheal tubes increased significantly (44% to 72%, P = .001).
- Severe tracheal intubation-associated adverse events decreased from 18.8% to 9.2% (P = .03).
- Post-intubation cardiac arrest events were eliminated, decreasing from 6.3% to 0% (P = .02).
Conclusions:
- A simulation-based collaborative intervention program effectively improved pediatric airway management practices and patient outcomes in general emergency departments.
- The study demonstrates the successful transfer of skills and improvements from a simulated setting to actual clinical practice.
- This intervention model shows promise for application in other clinical settings to enhance pediatric critical care.
Background:
In general emergency departments, advanced airway management of pediatric patients who are critically ill has been associated with increased adverse events given the varying exposure to pediatric patients and limited resources. Previous studies have shown significant improvement of simulated pediatric airway management in general emergency departments. The aim of this retrospective study was to determine the effect of an in situ simulation-based collaborative intervention program on the actual care of pediatric airway management in general emergency departments.
Methods:
This was a retrospective study of pediatric subjects who were critically ill and required intubation at a diverse set of general emergency departments before referral to the academic medical center. The primary outcome was the quality of clinical care measured by adherence to best practices via a critical action checklist. Secondary outcomes included tracheal intubation associated adverse events and clinical outcomes.
Results:
A total of 135 pediatric subjects (48 pre- and 87 post-intervention) who were transferred to the academic medical center from 9 general emergency departments between May 2014 and August 2019 were included in the analysis. The use of a cuffed endotracheal tube improved, from 44% to 72% (P = .001), whereas there was no significant change in the appropriate endotracheal tube size. Overall, severe tracheal intubation associated adverse events decreased, from 18.8% to 9.2% (P = .03), and post-intubation cardiac arrest events decreased, from 6.3% to 0% (P = .02).
Conclusions:
A simulation-based collaborative intervention program led to improvement in pediatric airway management and subject outcomes in general emergency departments. This model demonstrated the transfer of improvement from a simulated setting to a clinical setting and may be targeted in other clinical settings.
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