The effect of time constraints on resident performance in pediatric mock scenarios

Hospital-based rapid response teams (RRTs) and code teams are expected to respond to acutely decompensating patients within a defined time. However, there is limited data regarding the effect of this defined response time on the performance of the activating team. Residents are commonly the first responders to acutely decompensating patients in the hospital setting and their ability to recognize the need for an RRT or code activation along with their skills in patient management until the responding team arrives appear to be important for patient safety. We sought to evaluate the effect of time constraints on the performance of pediatric residents during simulated clinical scenarios that require activation of the pediatric RRT or pediatric code team.

We performed a single-center, prospective cohort study to analyze pediatric resident performance during low-fidelity simulated clinical scenarios involving acutely decompensating patients requiring pediatric RRT or pediatric code team activation. Simulated clinical scenarios were performed by residents without a time constraint (pre) and again with a time constraint (post) and residents were blinded to whether a time constraint had been applied. Statistical analysis was performed using a two-sided t-test to compare the number of interventions performed and time to activation of the pediatric RRT or code team for pre- vs. post-time constraint groups. Effect size was measured using Cohen's d.

Implementing a time constraint did have a medium to large effect (Cohen's d = 0.60) on pediatric resident performance and resulted in 6.2% increase in interventions performed in simulated clinical scenarios. Differences did exist based on the level of resident experience, with senior residents activating the pediatric RRT or pediatric code team faster than junior residents.

Implementation of a time constraint did have a moderate to large effect on the performance of pediatric residents during simulated clinical scenarios involving hospitalized acutely decompensating patients.