Situational Awareness of Sepsis by Residents in a Virtual Reality Simulation

Sepsis is a major cause of pediatric mortality that can be mitigated by early intervention. Residents are often the first physicians to assess septic patients and must both recognize sepsis and effectively communicate the diagnosis to the interprofessional team-achieving both individual and team situational awareness. To inform resident educational interventions that may improve clinical outcomes, we must first understand the drivers of current practice. We sought to assess differences in rates in pediatric resident recognition of sepsis on an individually completed questionnaire versus verbalization of a concern for sepsis to the interprofessional team during a virtual reality (VR) simulation. We additionally compared resident performance to providers with expertise in pediatric critical care or emergency medicine.

This retrospective observational cohort study is a secondary analysis of 68 VR simulations involving provider-nurse teams assessing and managing a pediatric patient with sepsis. Provider responses verbalizing a concern for sepsis during the simulation were compared to responses on an individual questionnaire asking for the diagnosis of concern.

In our sample, residents (n = 33) verbalized their concern for sepsis less frequently than experts (P = .03) and verbalized that concern less frequently than their rate of endorsing a concern for sepsis on the questionnaire (P = .004).

These findings suggest that while pediatric residents recognize sepsis, barriers may persist to verbalizing that concern in the moment-hampering development of team-level situational awareness. Educational curricula for residents targeting team communication skills may improve team-level situation awareness and ultimately patient outcomes.